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Corbett, Gina M. "The Corbett Pain Scale : a multidimensional pain scale for adult intensive care patients /." VCU Scholars Compass, 2006. http://hdl.handle.net/10156/1432.
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Goldfarb, Allison. "Increasing Practitioner Knowledge of Ketamine as an Adjunct Analgesic for Postoperative Pain." UNF Digital Commons, 2014. http://digitalcommons.unf.edu/etd/517.
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Postoperative pain is of serious concern to patients and anesthesia providers alike. Management of a patients’ pain is a central component of anesthesia care. Ketamine as an anesthetic agent has been available for 50 years. It has been utilized as a general anesthetic and selectively as an anesthetic agent for high-risk patients. Due to dysphoric side effects associated with the dosage required to render general anesthesia, anesthesia providers may be reluctant to utilize this medication to its full potential. Recently there has been a resurgence of interest in ketamine as an analgesic agent. The researcher for this project performed a thorough literature review focusing on intravenous ketamine as an adjunct to standard opioid-based analgesia for postoperative pain. Four systematic reviews published in the last 10 years support the safety and efficacy of ketamine when administered intravenously in sub-anesthetic doses. The purpose of this project was to provide evidence-based education to anesthesia providers regarding the benefits of ketamine and follow-up to evaluate for evidence of changes in practice after the educational At a large community hospital data concerning ketamine utilization by anesthesia providers as a component of multimodal analgesia was collected for a six-month period, including three months pre- and three months post-educational intervention. Despite various methods utilized to present evidence regarding the safety and efficacy of ketamine, the results of this study demonstrated no significant change in practice. Based upon the extensive published literature the evidence is compelling that the addition of a sub-anesthetic (0.5 mg/kg) dose of ketamine to the surgical patient’s operative pain management plan would improve comfort and decrease opioid-related side effects with minimal negative impact.
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Lind, Anne-Li. "Biomarkers for Better Understanding of the Pathophysiology and Treatment of Chronic Pain : Investigations of Human Biofluids." Doctoral thesis, Uppsala universitet, Anestesiologi och intensivvård, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-326180.
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Chronic pain affects 20 % of the global population, causes suffering, is difficult to treat, and constitutes a large economic burden for society. So far, the characterization of molecular mechanisms of chronic pain-like behaviors in animal models has not translated into effective treatments. In this thesis, consisting of five studies, pain patient biofluids were analyzed with modern proteomic methods to identify biomarker candidates that can be used to improve our understanding of the pathophysiology chronic pain and lead to more effective treatments. Paper I is a proof of concept study, where a multiplex solid phase-proximity ligation assay (SP-PLA) was applied to cerebrospinal fluid (CSF) for the first time. CSF reference protein levels and four biomarker candidates for ALS were presented. The investigated proteins were not altered by spinal cord stimulation (SCS) treatment for neuropathic pain. In Paper II, patient CSF was explored by dimethyl and label-free mass spectrometric (MS) proteomic methods. Twelve proteins, known for their roles in neuroprotection, nociceptive signaling, immune regulation, and synaptic plasticity, were identified to be associated with SCS treatment of neuropathic pain. In Paper III, proximity extension assay (PEA) was used to analyze levels of 92 proteins in serum from patients one year after painful disc herniation. Patients with residual pain had significantly higher serum levels of 41 inflammatory proteins. In Paper IV, levels of 55 proteins were analyzed by a 100-plex antibody suspension bead array (ASBA) in CSF samples from two neuropathic pain patient cohorts, one cohort of fibromyalgia patients and two control cohorts. CSF protein profiles consisting of levels of apolipoprotein C1, ectonucleotide pyrophosphatase/phosphodiesterase family member 2, angiotensinogen, prostaglandin-H2 D-isomerase, neurexin-1, superoxide dismutases 1 and 3 were found to be associated with neuropathic pain and fibromyalgia. In Paper V, higher CSF levels of five chemokines and LAPTGF-beta-1were detected in two patient cohorts with neuropathic pain compared with healthy controls. In conclusion, we demonstrate that combining MS proteomic and multiplex antibody-based methods for analysis of patient biofluid samples is a viable approach for discovery of biomarker candidates for the pathophysiology and treatment of chronic pain. Several biomarker candidates possibly reflecting systemic inflammation, lipid metabolism, and neuroinflammation in different pain conditions were identified for further investigation.Uppsala Berzelii Technology Centre for Neurodiagnostics
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Sjölund, Karl-Fredrik. "Experimental and clinical studies on adenosine receptor stimulation in cutaneous hypersensitivity and neuropathic pain /." Stockholm, 1998. http://diss.kib.ki.se/1998/91-628-3209-3/.
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Craine, Chloe I., and L. Lee Glenn. "Pain Assessment and Staff Attention to Pain in Nursing Homes." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/7471.
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Excerpt: The conclusions by Boerlage, Masman, Hagoort, Tibboel, Baar, and Dijk (2010) were interesting, but the supports for the conclusions were weak because of a number of shortcomings. The many weaknesses would prevent the immediate adoption of those conclusions in a health care setting.
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Green, Kemble L., and L. Lee Glenn. "Blinding and Controls in Postoperative Percutaneous Pain Management." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/7475.
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Excerpt: Gavronsky, Koeniger-Donohue, Steller, and Hawkins (2012) concluded that, 48 hours after major pelvic surgeries for cancer, the women in their study experienced equivalent pain relief from either manual acupuncture or percutaneous electrical nerve stimulation. This statement was not supported by the study data because of the lack of blinding and insufficient controls. Despite the numerous strengths of the study, due to weaknesses in the study design with regard to blinding and control groups, the addition of acupuncture to percutaneous electrical nerve stimulation should not yet be ruled out as a method of obtaining enhanced pain relief.
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Blackwelder, Reid B. "Chronic Pain Syndrome." Digital Commons @ East Tennessee State University, 2002. https://www.amzn.com/1560534400.
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Book Summary: This new reference ― part of The Secrets Series® provides balanced coverage of all current complementary and alternative therapies by leading experts in the field. Discusses each CAM modality and the disorders for which it has been proven beneficial; what to look for in a practitioner of each field; whether there is a "best" CAM approach; supporting evidence; and the effectiveness of CAM compated to allopathic approaches. Includes chapters on the various alternative therapies as well as chapters on medical disorders and the CAM treatments for those diseases Focuses on the evidence for the effectiveness of CAM therapies Kohatsu one of the leaders in the field (member of first group of fellows of Andrew Weil at University fo Arizona Department of Integrative Medicine Book uses an "integrative" approach---not just CAM therapies, but therapies used in conjunction with total program for treating patient's condition (including standard medical therapies, nutrition, etc). Concise answers that include the author's pearls, tips, memory aids, and "secrets".
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Holt, Jim, and Grant Studebaker. "Pain Management SAM." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6460.
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Holt, Jim, and Grant Studebaker. "Pain Management SAM." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6462.
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Da, Costa Kathryn T. "The pain relief paradox : an investigation of the discrepancy between retrospective pain relief and pain intensity." Thesis, University of Hull, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.252609.
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Blackwelder, Reid B. "Chronic Pain Management." Digital Commons @ East Tennessee State University, 2003. https://dc.etsu.edu/etsu-works/6991.
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Blackwelder, Reid B. "Chronic Pain Management." Digital Commons @ East Tennessee State University, 2002. https://dc.etsu.edu/etsu-works/6996.
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Olojugba, Oluwakanyinsola K. "The effect of pain site on the experience of pain." Thesis, University of Hull, 2009. http://hydra.hull.ac.uk/resources/hull:2391.
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This portfolio is made up of three parts. Part one is a systematic literature review in which the theoretical, conceptual and empirical literature relating to male and female experiences of chronic pain is reviewed. Part two is an empirical paper which uses IPA methodology to explore the influence of pain site on the female experience of chronic pain. Part three comprises the appendices
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Hanson-Parkes, Jannae. "Chronic pain." Online version, 2002. http://www.uwstout.edu/lib/thesis/2002/2002hansonparkesj.pdf.
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Furstein, James. "Sciatic Peripheral Nerve Blockade for Pain Control Following Hamstring Autograft Harvest in Adolescents: A Comparison of Two Techniques." VCU Scholars Compass, 2016. http://scholarscompass.vcu.edu/etd/4165.
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Anterior cruciate ligament reconstruction utilizing a hamstring autograft is a surgical technique that has gained popularity among orthopedic surgeons caring for adolescent patients. While utilization of a hamstring autograft is a revered technique, harvest of the hamstring yields significant pain. Sciatic peripheral nerve blockade has proven to reliably provide analgesia at the hamstring donor site. Single-injection sciatic peripheral nerve blockade is considered a basic and effective technique, making its use following anterior cruciate ligament reconstruction standard practice in many institutions. The duration of action of a single-injection sciatic peripheral nerve blockade may fail to outlast the pain arising from the hamstring donor site, prompting some clinicians to employ continuous sciatic peripheral nerve blockade via an indwelling catheter. A lack of comparative effectiveness studies exists in the literature regarding the duration of action of peripheral nerve blockade necessary to adequately provide pain control following hamstring autograft harvest, resulting in disagreement among clinicians as to best pain control practices. Proponents of continuous sciatic peripheral nerve blockade assert that while more costly, the extended duration of analgesia afforded by this technique improves pain control postoperatively and decreases the use of other pain medications. Advocates of single-injection sciatic peripheral nerve blockade cite concerns associated with continuous sciatic peripheral nerve blockade known to be detrimental to rehabilitation, such as decreased active knee flexion and increased risk of falls. The purpose of this research is to compare the effect of single-injection sciatic PNB to continuous sciatic PNB on 1) postoperative pain control as measured by self-reported pain scores, pain medication use, and unplanned hospital admission due to poor pain control, 2) active knee flexion, and 3) patient satisfaction with pain control following ACL reconstruction with a hamstring autograft. The findings of this study have the potential to guide informed clinical reasoning and decision making regarding sciatic peripheral nerve blockade techniques following hamstring autograft harvest in adolescents undergoing anterior cruciate ligament reconstruction.
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Blackwelder, Reid B. "Strategies in Chronic Pain Management." Digital Commons @ East Tennessee State University, 2001. https://dc.etsu.edu/etsu-works/7000.
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McConaghy, Paul M. "Secondary hyperalgesia and postoperative pain." Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.387878.
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Blackwelder, Reid B. "Practical Approach to Chronic Pain Management." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/6980.
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Blackwelder, Reid B. "Patient-Centered Approach to Pain Management." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/6981.
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Blackburn, Alison. "Living with pain or living in pain : narrative journeys with low back pain." Thesis, Northumbria University, 2011. http://nrl.northumbria.ac.uk/1536/.
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This study used a qualitative method to focus on the perspectives, beliefs and expectations of low back pain sufferers. The research was undertaken within a hospital based pain clinic. In recent years low back pain research has proliferated, and the epidemiological evidence suggests that back pain is an increasing problem. Much attention has been paid to the impact of low back pain on the population, and to the increasing cost in economic and health terms. Biomedical and psychological evidence abounds to shape acute and chronic management of low back pain, but there is a dearth of information about the viewpoint of those suffering pain. This study attempted to bring the understanding of the back pain sufferer to the fore. Issues of quality of life, functional ability and the impact of back pain on their lifestyle were explored, along with the influence of contextual factors in relation to how back pain sufferers perceived themselves and how others perceived them. A narrative method was utilized to illuminate the journey with pain. Nine interviews were conducted, and the interpretation and presentation of the narratives generated was influenced by Ricoeur’s interpretative theory. Thematic analysis revealed that doctorability, agency, control, separation or acceptance of the pain and the concept of future life were key features within the narratives. The analysis highlighted that for the majority in this study pain arrived uninvited following a traumatic accident or incident, and back pain became a chronic condition. It was always unwanted and initially it was unexpected as the usual script for pain is one of a transient incapacity followed by recovery. It was precisely this deviation from the norm that resulted in difficulties for the people suffering the pain. Biographical differences did not appear to be identifiable in the themes discerned in the stories, nor in the overall structure.
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Farmer, Adam Donald. "Human psychophysiological responses to visceral and somatic pain : the development of integrated, reproducible human pain phenotypes." Thesis, Queen Mary, University of London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.531465.
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Abstract Background Pain is the ubiquitous human experience, yet displays considerable inter- and intraindividual variability in health and disease. Many factors have been proposed to account for these differences. Pain activates a complex stress response, multiply determined through genetic, psychological, physiological and neuroanatomical factors. Chronic pain is a central defining characteristic of functional gastrointestinal disorders. They represent a major challenge for modern health care. An integrated understanding of the pathophysiology of these disorders remains to be elucidated. Aims To investigate human psychophysiological responses to visceral and somatic pain in health and disease, in order to develop multidimensional and reproducible pain phenotypes. Methods Study I, in healthy volunteers, investigated personality traits, hypothalamic pituitary adrenal axes and selective novel non-invasive measures of autonomic tone in response to visceral and somatic pain. Study 2 examined the salience of genetic polymorphisms of the serotonin transporter. Study 3 evaluated the reproducibility of these responses after a period of one year. Study 4 utilised the methods of studies I and 2 in a case control study of patients with functional chest pain. Key Results Studies I, 2 and 3 - Two pain phenotypes, or clusters, were found - cluster I (39%) had higher neuroticism scores, with higher sympathetic and hypothalamic pituitary adrenal axis tone at rest, and a predominant parasympathetic response to pain in the presence of the short allele of the serotonin transporter. Cluster 2 (61 %) displayed the converse profile in the absence of the short allele. These responses were stable at an interval of one year. Study 4 - similar phenotypes were observed in patients with functional chest pain, although the Cluster I phenotype was overrepresented in patients in comparison to the controls (71 % vs. 29%). Conclusions and Inferences This series of studies provides evidence for the existence of two reproducible human pain phenotypes in health, which have clinical salience in patients with functional chest pain. By phenotyping pain responses, subject homogeneity in future studies may be improved. Furthermore, such phenotyping techniques may open new therapeutic avenues by facilitating the selective targeting of nociceptive aberrancies, particularly in functional gastrointestinal disorders.
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Connolly, Gayle Wood. "Pain in multiple sclerosis." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/5115/.
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Multiple Sclerosis (MS) is a chronic, progressive disease which presents as a variety of cognitive, motor and sensory deficits (Compston and Coles, 2008). Pain is one of the most common and often severe symptoms of the disease. It is associated with poorer general health, and its management is therefore an important therapeutic target. People with MS can suffer from neuropathic pain as a direct result of damage to the central nervous system, or nociceptive pain, as a result of changes to the musculoskeletal system, secondary to disease progression. This was the first epidemiological study to measure the prevalence, characteristics, and impact of MS-related pain, using validated, IMMPACT-recommended measures. Neuropathic pain, common in MS, is a challenge to manage and is shown to impact on a person health-related quality of life (HR-QOL). Subsequently, the second part of this study explored the impact of Transcutaneous Electrical Nerve Stimulation (TENS) on neuropathic pain in MS, in a randomised controlled trial. A postal survey design was used to target the MS population of the NHS Ayrshire and Arran health board area, who completed a questionnaire on their pain experience (n=302). Clinically significant pain, defined as ongoing bothersome pain, was experienced by over two-thirds (71.5%), whilst chronic pain, defined as pain present for at least six months, was experienced by over half (59.2%) of the MS population. Neuropathic pain, assessed using the PainDETECT screening tool, was experienced by almost one third (32.7%) of the sample, with a further 14.7% identified as potentially having neuropathic pain. Thus 47.4% of the sample could potentially have neuropathic pain, which is higher than previous estimates, and that experienced by the general population. Approximately half the population experienced painful tonic spasms (44.5%) and dysaesthetic pain (56.2%). Burning pain, unpleasant paraesthetic sensations (i.e. crawling, tingling), and sharp pain were commonly experienced in the population with neuropathic pain. Multiple logistic regression analysis revealed Type of MS (p=0.001) and disability level (Guys Neurological Disability Scale (GNDS) (p<0.001) as independent predictors of neuropathic pain, possibly related to the pathophysiology of the disease. Neuropathic pain was shown as statistically more severe (using the 11-point Numerical Rating Scale of pain intensity (NRS-11) (p<0.001), more emotionally unpleasant (using the SF-MPQ) (p<0.001), with greater sleep disturbance (p<0.001), than nociceptive pain. Despite over two-thirds (68.5%) of those with neuropathic pain currently using prescribed, pain-relieving medication, over half (53.7%) still experienced severe (7-10 on NRS-11) pain. The presence of neuropathic also had a significantly negative impact on HR-QOL (EQ-5D) (p<0.001). The results of the epidemiological study increase understanding of the extent and demanding nature of pain in MS. Clinically, it will also facilitate timely screening for the neuropathic pain subtype, to minimise its impact on HR-QOL. Following the epidemiological findings, a randomised, double-blind, placebo-controlled trial, explored the efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) in the treatment of chronic, neuropathic pain in MS (n=46). Participants were recruited from the MS Service, NHS Ayrshire and Arran, with a diagnosis of lower limb neuropathic pain (score of ≥19 on the PainDETECT Screening tool for neuropathic pain), experienced for a minimum of six months. For the active TENS group, standard ‘Conventional’ TENS settings were applied, whilst a low frequency, low intensity, long pulse duration electrical current was used for the placebo application, which has no known analgesic effect, but still provides a sensory stimulus. Both groups used the TENS machine for a minimum of four hours/day, for a two-week period. Two long self-adhesive, hypo-allergenic electrodes were placed paravertebrally over the lumbar spine to stimulate the spinal nerve roots. The primary outcome measure was the (NRS-11), whilst secondary outcome measures included the Neuropathic Pain Scale (NPS), and the Patients Global Impression of Change (PGIC). Level of pain related interference on function was measured using the Brief Pain Inventory (BPI). Compared to the control group, the group receiving active TENS demonstrated a statistically (p<0.001) and clinically significant reduction in the intensity of neuropathic pain over the two-week intervention period. It was particularly effective for the burning, and sharp neuropathic pain qualities, that were commonly associated with neuropathic pain in the epidemiological study. TENS was also shown to reduce the emotional unpleasantness of pain (the affective component), which was high in those with neuropathic pain in the epidemiological study. This may have implications for the role of TENS in managing the psychological aspect of chronic neuropathic pain. TENS has no effect on pain–related interference on function, possibly due to the relatively short TENS intervention period. Future studies should explore longer intervention periods to explore the longer-term effects of TENS for pain in MS. The pharmacological management of neuropathic pain is not without its challenges. TENS as an inexpensive, non-invasive modality, with no side-effects, could be considered for the management of neuropathic pain, a common phenomenon in the MS population.
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Sato, Kaori D. "Pain medication use by participants in a yoga study for chronic low back pain." Thesis, Boston University, 2013. https://hdl.handle.net/2144/21249.
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Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Recent studies have shown the efficacy and practicality of the integration of complementary and alternative therapies and biomedical treatments for various diseases and illnesses, including high blood pressure, diabetes, epilepsy, and cancer. Saper et al. (2013) demonstrated that once-weekly yoga classes were equally as effective for relieving chronic low back pain in low-income, minority populations than twice-weekly yoga classes. Pain medication data collected from this 12-week study was used to examine the effect of yoga on analgesic use. Pain medications were categorized into four major groups: (1) acetaminophen, (2) opiates, (3) non-steroidal anti-inflammatory drugs (NSAIDS), and (4) other. The average number of NSAID pills taken daily decreased from baseline to 12 weeks. In addition, there was no statistically significant difference in the average number of any type of analgesic taken between once- and twice-weekly yoga groups from baseline to 12 weeks. Our findings suggest that yoga is most useful for individuals with mild to moderate chronic low back pain; however, further studies with more powerful sample sizes must be conducted in order to make more precise conclusions.
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Lee, R. J. E. "Chest pain at rest : A prospective evaluation." Thesis, Queen's University Belfast, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.373009.
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Anie, Kofi Arhu. "Sickle cell pain : outcome and psychological factors." Thesis, St George's, University of London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249293.
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Walsh, Kevin John. "An epidemiological study of low back pain." Thesis, University of Southampton, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.385367.
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Williams, M. Michele Potter Williams. "Nurses' Knowledge of Pain Assessments and Reassessments Impacts Hospitalized Patients' Reporting of Pain." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2305.
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Ineffective pain management can prolong a patient's length of stay and increase cost of care. Inadequate pain control decreases the patient's quality of life and contributes to poor health outcomes. A recent record audit showed that documentation of pain reassessments occurred only 20% of the time within an hour after administering pain medication. Furthermore, nurses may have insufficient knowledge regarding pain assessments and reassessments or hold irrational fears about addiction leading to inadequate treatment of pain. The purpose of this quality improvement project was to evaluate the effectiveness of an educational program for acute care nurses for the assessment and management of the adult hospitalized patient experiencing pain. Guided by Knowles theory of adult learning, nurses' knowledge regarding pain, assessments, and pain reassessments were evaluated before and after the pain management education program using the Knowledge and Attitude toward Pain Survey (KAPS). A convenience sample of 34 nurses completed the KAPS before and after an educational program addressing pain assessments. Results of the t-test analysis revealed a statistically significant (t = -15.8, df = 33, p<0.00) increase in KAPS scores, from an average pretest score of 70% to an average posttest score of 94%. The results of this project are consistent with the literature, and they illustrate the importance of improving nursing practice by providing nurses with education regarding pain assessments and reassessments as a strategy to improve the management of patients' pain and, resultantly, increase patients' quality of life.
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Oladoyinbo, Abidemi. "How well is paediatric pain managed in a private hospital in London? An evaluation of paediatric healthcare providers' pain management practices and parents' perception of pain management in their hospitalized children." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29221.
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Background: Optimal pain relief in a healthcare setting relies heavily on actual pain management practices rather than just on the healthcare practitioner’s knowledge of this. Understanding parents' perceptions of pain management practices are very important in identifying areas of concerns and in developing plans and strategies for improvement. Although research has examined these practices in various public healthcare settings, no research has been carried out within the private sector.
Aims/Objectives: This study aims to evaluate pain management practices of paediatric healthcare providers and parental perception of these practices within a private hospital in London. Its main objectives to evaluate paediatrics health care providers’ pain management practices against the recommended standard within the UK.
Methods: Using a Mixed method study design, 10 healthcare providers were observed and data was collected on pain management of 10 children over a period of 10 months (14 shifts). Interviews were also conducted with the corresponding 10 parents/caregivers of children involved in the study.
Results: The median age of child participant and health care providers were 3 and 32years respectively. Greater than half of the parent participants were Arabic while there was a fairly equal representation of white, Asian and black racial distribution among the health care providers. Although all healthcare provider could speak English, almost half of them could speak other languages, while greater than half of parent participant speaks Arabic. Pain assessment is routinely documented when the vital signs are checked, but recorded score may not correlate with the actual pain score of the child. This is due to lack of consistency and appropriate use of a validated pain tool for age. A potential lack of knowledge on how to utilise the various assessment tools may also contribute. Most parents were satisfied with the pain management of their child. They did indicate, however, the need to improve healthcare providers’ competencies and knowledge in the use of pain relieving devices as well as in the provision of supportive information for parents.
Conclusion: Overall, pain management practices in Harley Street were found to be satisfactory. Parental satisfaction with care provided could be attributed to the team approach utilised by healthcare providers in pain management. It is recommended that Harley Street Clinic needs to implement a paediatric specific pain management guidelines with regular auditing of pain management practices in the hospital. A review of pain management information given to parents of cardiac patients, as well as the provision of pain management information brochure in relevant languages may help improve care.
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Osborne, Scott. "Immunopathology of complex regional pain syndrome." Thesis, University of Liverpool, 2013. http://livrepository.liverpool.ac.uk/14485/.
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Both increased mast cells numbers and raised immune mediator concentrations indicate immune activation in the affected skin of patients with early CRPS, but little is known about regional immune cell involvement in late stage CRPS. The aim of the current study was to determine skin immune cell populations in longstanding CRPS. Using 6mm skin punch biopsies from CRPS-affected and non-affected tissues, and a combination of chemical and immunofluorescence staining, we examined the density and function of key cell populations including mast cells, epidermal Langerhans cells (LCs), and tissue resident T-cells. We found no significant differences in either overall immune cell infiltrates, or mast cell density between CRPS-affected and non-affected sub-epidermal tissue sections, contrasting recent findings in early CRPS by other groups. However, CD1a+ LC densities in the epidermal layer were significantly decreased in affected compared to non-affected CRPS limbs (p = <0.01). T-cell clones isolated from CRPS- affected sub-epidermal tissues displayed a trend towards increased IL-13 production in ELIspot assays when compared to T-cells isolated from non-affected areas, suggesting a Th2 bias. Immune cell abnormalities are maintained in late stage CRPS disease as manifest by changes in epidermal LC density and tissue resident T-cell phenotype.
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Richards, Helen Mary. "Responses to chest pain : a qualitative study." Thesis, University of Glasgow, 2001. http://theses.gla.ac.uk/6927/.
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Previous research has suggested the existence of socio-economic and gender variation in uptake of hospital cardiology services but it is not known at which stage of the care pathway these variations arise. This thesis aims to address this gap in the literature by exploring the perceptions of an behaviour in response to chest pain of men and women living in two socio-economically contrasting areas of Glasgow. It has 3 objectives: to describe respondents' perceptions of and actions in response to chest pain; to ascertain whether there are differences in perceptions and behaviour associated with socio-economic status or gender; and, to relate any observed differences to the known variations in uptake of cardiology services. Respondents' interpretations of chest pain were related to their perceived vulnerability to heart disease and their previous illness experience. Their decisions of whether to present to a general practitioner were influenced by the quality of previous encounters with doctors and by their lay care and self-care. Women generally felt less vulnerable to heart disease than men, and often believed that their health problems were secondary to those of family members. These factors led women to report a reluctance to present with chest pain. Compared with more affluent people, those from the deprived area generally felt more vulnerable to heart disease but the perception that they were to blame for their ill-health often led to reluctance to present with chest pain. Differences in perceptions and behaviour might partly explain gender inequities in access to hospital cardiology services but socio-economic inequities in uptake of services have proved more difficult to explain.
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Welsh, Victoria Kay. "Multisite pain and falls in older people." Thesis, Keele University, 2018. http://eprints.keele.ac.uk/4580/.
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Falls are a common occurrence in older people and multisite pain has been identified as a potential falls risk factor in this age group. This thesis aims to describe the relationship between multisite pain and falls in community-dwelling older people. A systematic review identified 20 studies investigating multisite pain and falls. Meta-analysis showed multisite pain increased the odds of falling. Data from the North Staffordshire Osteoarthritis Project, a prospective cohort study of community-dwelling adults aged ≥50 years with follow ups at three and six years, was used. Survey data was linked with general practice (GP) records, Hospital Episode Statistics (HES) and Office for National Statistics mortality data. Logistic regression tested the relationship between multisite pain and risk of self-reported falls in 4386 participants with complete data. Survival analysis tested the relationship between multisite pain and risk of GP or HES recorded falls in 11,375 participants. Analyses were adjusted for confounders and putative influencers of the pain-falls relationship. Multisite pain most strongly predicted future self-reported falls, followed by GP recorded falls. Multisite pain was not associated with HES recorded falls. Increasing age, being female, increasing number of medications used and strong analgesic use predicted all future falls; increasing cognitive complaint and previous self-reported fall additionally predicted GP recorded falls and all confounders and putative influencers predicted self-reported falls and had a significant association with multisite pain. These data suggest that multisite pain is an independent risk factor for self-reported falls. In addition, multisite pain is a likely influencer of the relationship between other risk factors and future falls. Primary care should proactively identify older adults with multisite pain due to their increased risk of falling and instigate falls prevention management according to current guidelines. Future research will establish the impact of pain management interventions on future risk of falls.
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Boshoff, Susan. "Absenteeism and musculoskeletal pain : an interactive network of variables." Master's thesis, University of Cape Town, 2000. http://hdl.handle.net/11427/3367.
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Campbell, William Ian. "Pain : assessing meaningful changes and pre-emptive treatment." Thesis, Queen's University Belfast, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.264089.
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Mackay, Wendy. "Assessing chronic pain : a first step to treatment." Thesis, University of East Anglia, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.296952.
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Price, Jill. "Investigations into central mechanisms of pain transmission." Thesis, University of Glasgow, 2001. http://theses.gla.ac.uk/4812/.
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The pain transmission system is inherently plastic in nature; plasticity of nociceptive processing in the dorsal hom of the spinal cord is believed to contribute to clinical states of post-injury pain hypersensitivity. Both enhancement and tachyphylaxis of nociceptive processing have been reported previously following repeated carrageenan-induced inflammation. The present study aimed to investigate central mechanisms involved in the transformation of pain transmission from 'physiological' to 'pathophysiological' in adult rats, using a model of mild intraplantar inflammation induced by intraplantar administration of carrageenan at doses markedly lower than those standardly used in research into central mechanisms of inflammatory pain transmission. Changes in plantar inflammation, thermal and mechanical sensitivity were assessed following intraplantar injection of repeated doses of carrageenan (0.5%, corresponding to a dose of 0.25 mg and 0.1 %, corresponding to a dose of 0.05 mg), administered at weekly (0.5% and 0.1 %) and daily (0.1%) intervals. Expression of mRNA of key genes implicated in plasticity of central spinal pain transmission in laminae I, II and V of the dorsal hom of the lumbar spinal cord (laminae involved in central nociceptive transmission) was investigated using in-situ hybridisation techniques. The genes investigated were calcium calmodulin kinase IIa (CaMKIla), a key intracellular molecule instantaneously activated by neuronal stimulation; alterations in CaMKIla expression can rapidly induce nociceptive plasticity through modulation of many excitatory and inhibitory nociceptive mediators; the cyclooxygenase enzymes COX-1 and COX-2, which catalyse prostaglandin synthesis and are implicated in the modulation of the central nociceptive response to inflammatory injury; the immediate early genes zif11268, junD and tissue plasminogen activator (tPA), which have been implicated in the induction and maintenance of neuronal plasticity in higher centres, and the precursors for the inhibitory neurotransmitter molecules y-amino butyric acid (GABA), enkephalin and dynorphin. A method for organotypic culture of neonatal spinal cord was developed and characterised with the aim of providing a useful technique for more detailed study of the molecular basis of nociceptive plasticity. Mild inflammatory injury induced by 0.5% and 0.1% carrageenan treatment induced consistent hyperalgesic behaviour, which did not change following weekly repeated injection. Temporary attenuation of hyperalgesia developed following daily repetitive administration of 0.1 % carrageenan, but hyperalgesia returned when this repetitive inflammatory stimulation was maintained. Preliminary studies on the role of NMDA receptors, opioid receptors and a 2A adrenoreceptors in the mediation of this tachyphylaxis suggest that these receptor systems did not playa major role in the observed tachyphylaxis In-situ hybridization studies did not identify changes in gene expression induced by repetitive carrageenan treatment in lamina V. In laminae I1II, changes were observed in expression of certain genes (notably CaMKIla, COX-2 and proenkephalin), but not of immediate early genes, GAD 67 or prodynorphin. Hyperalgesia associated with weekly carrageenan treatment correlated closely with significantly enhanced transcription of CaMKIla mRNA in laminae IIII; moreover, tachyphylaxis of hyperalgesic behaviour correlated with attenuation of CaMKIla upregulation. Since increased expression of CaMKIla, leading to regulation of expression of a range of kinase-dependent receptors and intracellular mediators, is a hallmark of neuronal plasticity in higher centers, this suggests that central plasticity of nociceptive transmission in the dorsal hom could have contributed to the development of hyperalgesia following carrageenan treatment. Weekly administration of carrageenan also consistently induced significant upregulation of COX-2 and proenkephalin mRNA expression in laminae I1II, suggesting that ultimate modulation of pain sensation following inflammatory injury is determined by the interaction of excitatory and inhibitory transmitter pathways. COX-I, prodynorphin and GAD 67 mRNA expression were not significantly changed in relation to the intensity of inflammatory injury or in relation to changes in nociceptive responses. This would suggest that these mediators did not play a key role in the modulation of spinal nociceptive transmission associated with mild inflammatory injury. With the possible exception of CaMKIla, changes in gene expression did not correlate closely with plasticity of nociceptive behaviour induced by daily repeated carrageenan treatment. 200 !lm transverse slices of postnatal spinal cord were cultured successfully for up to 5 days using a simple interface culture system. Histochemical and immunocytochemical assays indicated that the architecture of organotypically cultured spinal cord closely resembled that observed in-vivo. This study presents a new approach to the investigation of neuronal plasticity associated with tissue injury and inflammation. Different mechanisms underlying plasticity of nociceptive responses may be induced by induced by high intensity as opposed to lowintensity injury. The observation of tachyphylaxis of hyperalgesia following daily repeated carrageenan treatment may represent engagement of endogenous 'anti-hyperalgesic' mechanisms. Further investigation of the molecular basis of endogenous 'antihyperalgesia', facilitated by organotypic slice culture techniques, may identify new targets for the treatment and prevention of persistent pathological nociceptive transmission following inflammatory injury.
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Walker, Jan. "The management of elderly patients with pain." Thesis, Bournemouth University, 1989. http://eprints.bournemouth.ac.uk/357/.
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This research project is designed to determine a plan of assessment and intervention, which can be used by nurses in the community to help elderly patients cope with painful conditions. A theoretical model is developed, in which coping is defined in terms of the degree of control experienced over pain and other stressors. This model identifies emotional state as the indicator of coping at any particular time. A study is described, in which subjects were 190 retired patients, who were being visited by a district nurse, and who identified that they had persistent or recurrent pain. Data on pain and coping was collected using semi-structured interview. Mood state was measured as the dependent variable. Independent variables for quantitative analysis included pain intensity ratings, pain duration, disability, health, personal and financial problems, age and locus of control. Qualitative data were collected to validate the quantitative findings. Questionnaire data were collected from nurses for purposes of verification and comparison. Nonparametric correlations, and multiple regression analysis, identified that the variables which directly determined coping were feeling the pain to be under control, being occupied, feeling informed about the painful condition, having regrets and non pain-related personal problems (notably bereavement loss). Those who used active occupational and pain-relieving strategies coped better than those who adopted passive coping strategies. Patients generally valued supportive aspects of nursing care, particularly the provision of encouragement and confidence. Nurses systematically underestimated patients' worst pain and overestimated anxiety. There was a significant association between patients' pain complaints and perceived pain exaggeration. Few nurses used a pain assessment protocol, or had received formal education in the management of chronic pain. These results are used to produce guidelines for the nursing management of elderly patients with pain in the community, with particular reference to assessment and intervention, based upon the nursing process
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Jadad-Bechara, Alejandro Ricardo. "Meta-analysis of randomised clinical trials in pain relief." Thesis, University of Oxford, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.239290.
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Gracey, Jacqueline Helen. "Low back pain : current physiotherapy management in Northern Ireland." Thesis, University of Ulster, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365963.
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Chew, Daniel John. "Mechanisms involved in chronic neuropathic pain after avulsion injury." Thesis, Queen Mary, University of London, 2010. http://qmro.qmul.ac.uk/xmlui/handle/123456789/445.
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Motor vehicle accidents are the most common cause of injuries involving avulsion of spinal roots from the brachial or lumbosacral plexuses. This results in chronic intractable pain that is refractory to pharmacotherapy. This is largely due to lack of information on underlying mechanisms, and lack of an established animal model to test drug treatments. This thesis has: 1) compared the neuroanatomical effects of dorsal root rhizotomy (DRR) and avulsion (DRA) in the spinal cord. DRR is commonly used to model avulsion injury but unlike avulsion it does not damage the spinal cord, as often happens clinically. 2) Developed a behavioural model of spinal root avulsion injury (SRA). 3) Evaluated the behavioural effects of drugs prescribed to treat neuropathic pain or those used clinically to treat other conditions like motoneuron disease or spinal cord injury. DRA produced a greater and prolonged glial, inflammatory, vascular response and cell loss than DRR. SRA produced thermal and mechanical hypersensitivity in the affected hind-paw. Neurodegenerative and neuroinflammatory responses were observed in both the avulsed and adjacent spinal segments, but produced no changes in the neuronal phenotype adjacent dorsal root ganglion neurons, suggesting that the evoked behaviour is mediated by central mechanisms. Administration of amitriptyline or carbamazepine reduced behavioural hypersensitivity in SRA, confirming their limited clinical efficacy in treatment of avulsion injury. Minocycline and riluzole produced therapeutic efficacy. Both compounds prevented the establishment of behavioural hypersensitivity, which correlated histologically with microglial inhibition, although riluzole was transiently effective. Additionally, minocycline reversed the hypersensitivity, an effect that persisted beyond drug washout, whereas riluzole had a limited effect that only lasted whilst the drug was administered. This thesis provides insight into the mechanisms of avulsion-induced neuropathic pain. The establishment of a behaviourally reproducible avulsion model provides a platform to test new pharmacological candidates for treatment, such as minocycline.
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Mohseni-Bandpei, Mohammad Ali. "Chronic low back pain : a randomised controlled trial of spinal manipulation measuring pain, functional disability, lumbar movements and muscle endurance using surface electromyography." Thesis, University of East Anglia, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365048.
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Clark, Jamie E. "Treatment implications for prescription drug abuse and chronic pain a case study /." Online full text .pdf document, available to Fuller patrons only, 2004. http://www.tren.com.
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Himes, Alisha N. "An Historical Analysis of the Perception of Pain & Pain Management Methods from 1800-1945." Walsh University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=walsh1587571133744558.
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Rosenberg, Marisa. "Antinociceptive Effects of Monoamine Reuptake Inhibitors in Assays of Pain-Stimulated and Pain-Depressed Behaviors." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2715.
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ANTINOCICEPTIVE EFFECTS OF MONOAMINE REUPTAKE INHIBITORS IN ASSAYS OF PAIN-STIMULATED AND PAIN-DEPRESSED BEHAVIOR By Marisa B. Rosenberg A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University. Virginia Commonwealth University, 2012 Advisor: Sidney Stevens Negus, Ph.D. Professor, Department of Pharmacology/Toxicology Noxious stimuli can produce pain-related stimulation of some behaviors (e.g. withdrawal responses) and depression of other behaviors (e.g. feeding, locomotion, responding maintained by many types of positive reinforcement). Monoamine reuptake inhibitors are used clinically to treat depression and to manage some types of pain. This study examined the antinociceptive properties of a variety of monoamine reuptake inhibitors selective for SERT, NET and DAT in complementary assays of acute pain-stimulated and pain-depressed behaviors. Intraperitoneal injection of dilute lactic acid (1.8% in a volume of 1ml/kg) was used as a noxious stimulus to stimulate a stretching response and to depress intracranial self-stimulation (ICSS) of the median forebrain bundle. All eight monoamine reuptake inhibitors produced an antinociception-like blockade of acid-stimulated stretching, but only compounds with prominent DA reuptake inhibition (SDRIs RTI-113 and bupropion and the TRI RTI-112) were able to block acid-depressed ICSS, although these effects were produced only at doses that also produced an abuse-related facilitation of control ICSS. Selective or mixed-action inhibitors of 5-HT and NE failed to block acid-induced depression of ICSS. In a separate group of rats, citalopram was also tested using a repeated dosing regimen (10 mg/kg x 3 doses) shown previously to produce antidepressant effects in a forced-swim test in rats. As with acute administration, repeated citalopram decreased acid-stimulated stretching but failed to block acid-induced depression of ICSS. Taken together, these results suggest that SSRIs, SNRIs and S+NRIs produce relatively non-selective depression of all behavior rather than a selective blockade of sensory sensitivity to noxious stimuli. Conversely, dopamine reuptake may be able to block sensory detection of noxious stimuli. Additionally, these results suggest that assays of pain-depressed behavior can provide new insights on analgesia-related effects of monoamine reuptake inhibitors.
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Faircloth, Amanda. "Perceptions of Acupuncture and Acupressure by Anesthesia Providers." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3586.
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BACKGROUND: Randomized controlled trials show acupuncture and acupressure support anesthesia management by decreasing anxiety, opioid requirements and treating post-operative nausea and vomiting. Acupuncture and acupressure have demonstrated clinical usefulness and received governmental support (NIH, PPACA, WHO, U.S. Military), but have not yet diffused into mainstream anesthesia practice. This study examined US anesthesia providers' perceptions of acupuncture and acupressure.
METHODS: Ninety-six anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical centers, community hospitals, children’s hospitals, and VA hospitals) were selected for participation in an anonymous, online survey. The target sample was 1,728 providers of which N = 292 (54% anesthesiologists, 44% CRNAs, 2% AAs) responded yielding an overall 17% response rate.
RESULTS: Spearman’s correlation coefficient revealed a statistically significant correlation between acupuncture and geographic region, with the West having the highest predisposition toward acupuncture use (rs = 0.159, p = 0.007). Females are more likely to use acupuncture than men (rs = -.188, p = 0.002). Age yielded a moderate effect size with providers between the ages of 31-50 years old experiencing the best outcomes administering acupuncture (rs = 0.65, 95% CI = 2.79, 3.06). A strong effect size exists between acupuncture and country of pre-anesthesia training (rs = 1.00, 95% CI = 1.08, 1.16). Some providers have used acupuncture (27%) and acupressure (18%) with positive outcomes, however the majority of providers have not used these modalities, but would consider using them (54%, SD = 1.44 acupuncture; 60%, SD = 1.32 acupressure). Seventy-six percent of respondents would like acupuncture education and 74% would like acupressure education (SD = 0.43, SD = 0.44, respectively). Lack of scientific evidence (79%, SD = 0.73) and unavailability of credentialed providers (71%, SD = 0.92) were the primary barriers.
CONCLUSIONS: While most U.S. anesthesia providers have not used these modalities, they still report a favorable perception of acupuncture/acupressure’s role as part of an anesthetic and the majority of providers express an interest in receiving education. This study adds to the body of acupuncture and acupressure research by providing insight into anesthesia providers’ perceptions of these alternative medicine modalities.
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Liu, Sophia. "Continuity of care for pain, depression and psychosis in older adults." [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12092008-114900/.
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Newton, Mary. "Assessment and rehabilitation of chronic low back pain." Thesis, University of Glasgow, 1996. http://theses.gla.ac.uk/4250/.
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This thesis presents a set of studies which investigated chronic low back pain. The specific aim of this thesis was to develop reliable methods for the assessment and rehabilitation of chronic low back pain. The two assessment methods tested were a broad based clinical evaluation and an isokinetic assessment of trunk muscle strength. The first part of the thesis describes the reliability and validity studies of the clinical methods for measuring trunk mobility, trunk muscle strength, spinal shape and palpation. A total of 27 physical tests were studied using 70 patients and 10 normal subjects. Twenty-three of these tests were found to be reliable and were incorporated into the isokinetic assessment study. The second part of the study reports the standardisation and reliability studies for the isokinetic assessment of trunk muscle strength in 70 normal subjects and 120 patients with chronic low back pain. The results showed that the main isokinetic measures were reliable for both normal subjects and patients. There was a significant learning effect from test 1 to test 2 in both normal subjects and patients. The magnitude of this learning effect was greater in patients than normal subjects. The normal subjects were followed up by a postal questionnaire in a two year prospective study to predict future back pain using the isokinetic measures. None of the measures used showed any significant differences between those subjects who developed back pain and those who did not. The third part of the thesis describes studies to develop a rehabilitation programme for patients with chronic low back pain using the isokinetic machines, both as a means of monitoring progress and as an exercise regime. The first study of 26 patients indicated that the programme was safe and effective, but also revealed a major problem with adherence to a six week exercise programme. The second study investigated the problem of adherence and examined the time course of response to isokinetic exercise by repeating the tests at three weeks and six weeks.
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Rosano, Guiseppe Massimo Claudio. "Studies on patients with chest pain and normal coronary arteriograms." Thesis, Imperial College London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312377.
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Johnson, Caroline Elizabeth. "An intelligent computer assisted learning environment for acute abdominal pain." Thesis, University of Liverpool, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.274592.
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Cooke, Richard. "Investigations of patients with chest pain and normal coronary angiograms." Thesis, Queen's University Belfast, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.336674.
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Levell, Jayne. "Response expectancy for spinal cord stimulation in chronic pain patients." Thesis, University of Leeds, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275556.
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