The research reported in this dissertation centered around the prevalence and factors associated with low back pain (LBP) among the undergraduate physiotherapy students at the University of the Witwatersrand. Physiotherapy students are prone to LBP due to a flexion posture while studying, lifting patients and working. After pathology, muscle activity is influenced, affecting optimal function of the spine. Preventative strategies can minimise recurrences of LBP. Physiotherapy students enrolled for 2010 at the University of the Witwatersrand participated in a cross-sectional prevalence study. A questionnaire, multi-stage fitness test and physical assessment were completed. Statistical analysis was done with univariate analysis for associations with LBP. The study revealed that the lifetime LBP prevalence was 35.6% among all four physiotherapy year groups. The prevalence increased from first year to third year but unexpectedly decreased in the fourth year group. Significant associations with LBP were posterior-anterior mobilisations on L4 (p=0.003) and L5 (p≤0.001) centrally, left lumbar multifidus (LM) cross-sectional area (p=0.02), right obliquus internus abdominis (p=0.02) and transversus abdominis (TrA) thickness at rest (p=0.03), both TrA during contraction, left (p=0.02) and right (p=0.01), as well as the pull of the TrA during contraction on the left (p=0.03). The present work is the first study to show measurements with ultrasound imaging of LM and TrA on physiotherapy students. The prevalence of LBP might be reduced if students are more aware of LBP and consequential muscle imbalances that might perpetuate the problem. The dissertation concludes with a discussion of future research avenues. It is suggested that an intervention to make students aware of LBP and risk assessments in South Africa will help to identify and address hazards in the workplace.

MMed, Faculty of Health Sciences, University of the Witwatersrand / Postoperative pain is prevalent and not optimally managed in most patients. Pain can lead to adverse emotional and systemic consequences. Numerous device orientated studies have been done in other countries looking at the effect of infusions of local anaesthetic at the wound site postoperatively via an elastomeric pump. There have however been no similar studies done in South Africa. The aims of this study was to assess whether the use of an incisional wound catheter and 0.39% bupivacaine infusion in patients post total abdominal hysterectomy for a 30 hour period will decrease opioid requirements compared to a control group having only systemic analgesia. Pain intensities were also documented at set observation periods. The opioid requirements between the 2 groups were comparable however the participants who had the bupivacaine infusion in their incisional site had less pain intensity scores until 6 hours post operation and had less pain intensity on movement at 30 hours post operation. A bupivacaine infusion in the incisional site decreases pain intensity in the above mentioned parameters but does not reduce opioid requirements.

Aims: The primary aim of this thesis was to explore the role of palliative radiotherapy in the treatment of pain in malignant pleural mesothelioma (MPM). The effect of radiotherapy on other symptoms was also examined. Biomarkers which might predict response to radiotherapy (Quantitative Sensory Testing – QST) were explored and objective evidence of response was sought via interpretation of Computed Tomography (CT) scans. The thesis also examined the role of Positron Emission Tomography (PET)-CT in radiotherapy planning and characterising pain in MPM. Methods: A narrative review of the challenges of pain management in MPM and a systematic review of the evidence supporting the use of palliative radiotherapy for pain control in MPM, were undertaken. In addition, a multi-centre, single arm phase II trial was conducted which examined the role of radiotherapy in pain control in MPM. This trial also assessed the role of PET-CT in radiotherapy planning and allowed for a characterisation of MPM-related pain. These components form the basis of this thesis. Results: Palliative radiotherapy at a dose of 20 Gy in five daily fractions using 6 Megavoltage (MV) photons improves pain in a significant proportion of patients with MPM. It does not have a beneficial effect on other symptoms or on quality of life. QST does not appear to be a useful clinical biomarker indicating likelihood of response to radiotherapy. Objective evidence of response via CT is low. Incorporation of PET-CT in the radiotherapy planning process alters the anatomical location of the target volume in patients with MPM. There is also an association between the Standard Uptake Value (SUV) uptake and pain, with the areas with highest SUV uptake being associated with the areas of pain. PET-CT results in upstaging of a significant proportion of patients. Pain is often severe and debilitating for patients with MPM and it has often a combination of neuropathic and nociceptive mechanisms. The presence of a neuropathic component to the pain is not associated with an increased likelihood of response to radiotherapy. Conclusions: Radiotherapy is effective at relieving pain in a proportion of patients with MPM and should be considered for all patients with MPM-related pain. PET-CT improves multiple parameters in the radiotherapy planning process compared with CT alone. QST parameters have not been shown to predict those patients who are likely to respond to radiotherapy.

Chronic pain is one of the most significant medical and scientific challenges in western society today. As well as the emotional and physical effects on the individual it proves to be a significant financial burden to society. Studies have shown that chronic pain leads to central sensitisation that is partially regulated by release of proinflammatory molecules within the CNS. Most work has concentrated on the role of the spinal cord and little is known about changes in supraspinal regions. The CFA footpad model was used to investigate the expression of inflammatory mediators in the brain in persistent inflammatory pain. Using RT-PCR, gene expression of inflammatory mediators was measured in various brain regions. Consistent with previous reports at 7 and 14 days post-injection IL1β expression was significantly elevated in the posterior of the brain (p<0.05), TNFα showed differential expression with a significant increase in the posterior ipsilateral brain region at 72 hours (p<0.05). The chemokine CXCL1 was significantly elevated at 6 hours post-injection (p<0.05) suggesting a role for this chemokine in regulation of the acute pain response. Contrary to evidence from the spinal cord, CX3CL1 and its receptor CX3CR1 were down regulated in the brain at 6 and 24 hours post-injection. Differential expression of astrocyte activation was identified by GFAP immunochemistry. Hypoxia has been implicated in neurodegeneration, a process thought to play a role in chronic pain. Here Hypoxia inducible factor (Hif1α) mRNA expression within the brain was not altered in a CFA model of peripheral inflammation. Interestingly, using Hypoxyprobe immunohistochemistry, a higher level of hypoxia was identified in non-injected controls than in CFA treated animals. This is the first evidence of differential chemokine expression in the brain in persistent inflammatory pain and the first study to suggest a potential role for differential oxygenation within the brain in this condition.

by Yiu-chung Wong. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1991. / Bibliography: leaves 171-184. / Acknowledgements --- p.i / Abstract --- p.iii / List of Figures --- p.1 / List of Tables --- p.4 / Chapter Chapter 1 - --- General Introduction --- p.6 / Chapter Chapter 2 - --- A Gas-liquid Chromatographic Method for Studying the Effect of Adrenaline on Venous Plasma Concentrations of Bupivaca- ine after Interpleural Administration --- p.41 / Chapter Chapter 3 - --- Gas-liquid Chromatographic Determination and Physicoche- mical Studies of Six Clinical Used Local Anaesthetics --- p.64 / Chapter Chapter 4 - --- Improved Gas-liquid Chromatographic Method for the Quant- itation of Plasma Pethidine and Norpethidine --- p.88 / Chapter Chapter 5 - --- Determination of Pethidine and Its Major metabolites in Hu- man Urine by Cas-liquid Chromatography --- p.112 / Chapter Chapter 6 - --- Plasma Protein Binding Characterization of Pethidine and norpethidine --- p.131 / Chapter Chapter 7 - --- "A Comparative Study of Plasma Pethidine and Norpethidine in Caucasian, Chinese and Nepalese Patients after Intramus- cular Post-operative Pethidine" --- p.153 / Chapter Chapter 8 - --- Future Prospects of the Work --- p.168 / References --- p.171 / Appendices

A review of the relevant literature suggested a number of unresolved issues in the most efficacious use of TENS for pain-relief including the degree of control and the frequency of TENS. The study investigated the influence of giving subjects control of the TENS stimulus on reported pain intensity and unpleasantness during experimental ischaemic pain induction of the arm. The pain induction and assessment procedures were established during an initial series of three experiments. Subjects in these and the subsequent experiments were healthy female student volunteers from Queen Margaret College. A further series of experiments investigated the influence of control of the TENS intensity on VAS scores of pain intensity and unpleasantness. When used, TENS (symmetrical biphasic current; pulse duration 200ýts; intensity 'just perceptible') was applied for the 15 minutes prior to cuff inflation and during the 15 minutes of pain induction (electrodes placed over Erb's point and lateral to C6/7). The first TENS experiment investigated the. influence of three different conditions (experimenter controlling TENS intensity; subject controlling TENS intensity; no TENS) using high frequency (100Hz) TENS. All subjects (n=12) were randomly exposed to the three testing conditions using a repeated measures design. A 2-way ANOVA with repeated measures on both factors showed no statistically significant effects (p≥0.05) on either VAS pain intensity or unpleasantness scores. The procedure was repeated with different subjects (n=12) using low frequency (5Hz) TENS. The results showed that mean pain scores were statistically significantly lower (p≤0.05) in the subject control condition than in the other two conditions (experimenter control and no TENS). A final experiment (n=12) compared VAS pain intensity and unpleasantness scores between the three conditions of, subject controlling 100Hz TENS, subject controlling 5Hz TENS and no TENS. The results demonstrated a trend for the 5Hz TENS condition to give lower mean pain scores than the other two conditions with both intensity (p=0.239) and unpleasantness scores (p=0.110). From the results and discussion it was suggested that the pain-relieving benefit of TENS was enhanced when the subjects were given control of the current intensity, especially when using low frequency TENS. The clinical implications of the results are 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.

Congenital insensitivity to pain (CIP) is an extremely rare inherited disorder characterised by the inability to perceive physical pain from birth, resulting in a number of injuries including self-mutilation, repeated burns and fractures. A number of different genes underlying CIP have been identified over the years and all act principally either to direct development or function of nociceptors. In this dissertation, a number of unrelated families with CIP were recruited and novel missense and splicing mutations in NTRK1, NGF and SCN9A were identified in the cohort. The findings presented in this dissertation demonstrate how mutations in the NTRK1 gene can cause the phenotype of CIP, and increase our knowledge of the functions and the role of key residues of TRKA within the cell. I have verified the importance of NGF in the development of nociceptors and demonstrate the overlapping roles of the precursor proNGF with mature NGF as well as providing insight into the role of proNGF as a neurotrophic molecule, in contrast to the wider consensus. Moreover, I provide further evidence that splicing mutations are also responsible for CIP and highlight that splicing mutations are potentially missed in diagnostic labs. Lastly, I have demonstrated that stem cells can be used to study and generate different types of sensory neurons, indicating a potential use as a suitable platform for investigating monogenic disorders. The identification of novel genes, in addition to the dissection of the residues and pathways of known genes, is essential for the development of new analgesics.

Background Patellofemoral pain (PFP) is a common musculoskeletal complaint with inadequate long term outcomes. We aimed to review current evidence relating to tailored interventions, address knowledge gaps concerning how tailoring should best be delivered and establish whether such interventions are feasible. This thesis investigated whether the interaction of hip and foot biomechanics better explains PFP presentation and management, and could be used to inform feasibility studies of delivering tailored interventions for individuals with this recalcitrant condition. Methods Two systematic reviews with meta-analysis identified predictors of conservative management outcomes and the effects and mechanisms of proximal rehabilitation interventions. A reliability study tested a battery of clinical measures, designed to identify biomechanical deficits common in individuals with PFP. An observational study of individuals with PFP investigated possible biomechanical mechanisms of effect for in shoe foot orthoses. A case control study design explored the electromyographic activity of the gluteal region during common rehabilitation exercises. A randomised intervention trial implemented a tailored intervention to determine feasibility. Results Outcome predictors for conservative management are currently at a derivation stage of development. A clinical battery of 14 measures showed good intra and inter rater reliability for the assessment of lower limb biomechanics. Proximal rehabilitation, combined with quadriceps, achieves favourable outcomes in the short and medium term. Gluteal muscle electromyographic activity is comparable between symptomatic and asymptomatic individuals, with specific exercises achieving desired activation patterns. Tailored intervention using biomechanical characteristics, within a randomised trial, is feasible for recruitment and retention. Conclusion Interventions directed proximal and distal to the patellofemoral joint are effective in the management of PFP. Indicators of treatment success are at a derivation stage,with findings from this thesis providing a comprehensive clinical test battery for lower limb biomechanical assessment. Feasibility of a biomechanically determined tailored intervention has been established.with findings from this thesis providing a comprehensive clinical test battery for lower limb biomechanical assessment. Feasibility of a biomechanically determined tailored intervention has been established.

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>