Dissertations / Theses: 'Pain Self-management'

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Appleyard, Sara Elizabeth. "Self-management of cancer pain." Thesis, University of Hull, 2014. http://hydra.hull.ac.uk/resources/hull:11347.

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The portfolio has three parts: a systematic literature review, an empirical study and a set of appendices. Part one: Comprises a systematic literature review in which studies relating to the use of self-initiated pain coping strategies in adults with cancer are reviewed. Fifteen studies were included in the review, including qualitative, quantitative and mixed methods designs. The studies reviewed had to have explored pain coping strategies and have included patient characteristics such as demographic, psychological or clinical variables that would allow for the investigation of possible relationships between the two. Part two: Comprises an empirical paper which explores the experiences of older people who self-manage their cancer pain at home. Patients attended semi-structured interviews with the main researcher. These interviews were analysed using Interpretative Phenomenological Analysis (IPA). The data was analysed, emergent themes are presented and implications are discussed in regard to existing literature. Methodological limitations are discussed and potential areas for future research are identified. Part three: Comprises the appendices which support the work of the first two parts, and includes a reflective statement on the research process, an epistemological statement, and a worked example of IPA analysis.

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Hernandez, Carlos, and Marion Slack. "Self-management of Pain Among Pharmacy Students." The University of Arizona, 2016. http://hdl.handle.net/10150/613984.

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Class of 2016 Abstract
Objectives: The purpose of this study is to determine if pharmacy students are more likely to use pharmacological agents to manage pain and if men and women are equally likely to use pharmacological agents. Methods: Questionnaires were administered after a regularly scheduled class for first, second and third year pharmacy students. Data collected included a pain intensity rating, whether pain was acute or chronic, how the pain was managed (medication, exercise, etc.) and if pain interfered with activities. Results: A total of 218 students (41% men, 71% aged 19-25) participated; 70% reported acute pain, 16%, chronic pain, and 14%, no pain. Pain intensity was greater in the chronic pain group (5.8 ± 1.7) than in the acute pain group (5.0 ± 2.1; p = 0.028). Chronic pain respondents were more likely to use prescription NSAIDs, muscle relaxers, physical therapy, transdermal electrical nerve stimulation, steroid injections and beta blockers (p < 0.02). There were few differences between men and women; women used OTC NSAIDs and acetaminophen at higher rates than men (p < 0.02). Women also used two non-pharmacological strategies (changed position and relaxation) at higher levels than men (p < 0.02). Students with chronic pain reported more pain interference with daily and leisure activities (p < 0.005) and work (p = 0.003) than students in the acute pain group. Conclusions: Different strategies were used for pain management between acute and chronic pain participants, and also between both men and women. Students with chronic pain reported more interference with activities than those with acute pain.

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Azaril, Kim, Taness Billington, and Kelsey Garlick. "The Efficacy of Self-Management Programs for Chronic Pain: A Preliminary Review." The University of Arizona, 2017. http://hdl.handle.net/10150/624024.

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Class of 2017 Abstract
Objectives: To identify studies that have been conducted on pain self-management interventions to describe the strategies used in the treatment of pain Methods: Eligible studies were determined using a study inclusion-screening tool. To be eligible, studies needed to be randomized controlled trials comparing some type of self-management intervention to an alternative or usual care. Once determined to be eligible, selected studies were analyzed by two investigators using a consensus procedure and full article data extraction form which collected data on the study characteristics, patient characteristics, self-management strategies and relevant study outcomes. Results: The chronic pain management strategies from the 14 randomized controlled trials used in this study included: acupuncture, mobile based intervention, yoga, meditation/relaxation techniques, cupping therapy, musical therapy, cognitive behavioral therapy, physical therapy and self-management therapies. All studies showed a statistically significant reduction in pain from baseline, however, the effect size ranged from very small (0.02) to quite large (2.2). Conclusions: Most studies showed a meaningful reduction in pain, hence, a wide variety of self-management strategies are available for managing pain.

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Giannopoulou, Chrysoula. "Effectiveness of an Internet-based pain self-management intervention for individuals living with chronic pain." Thesis, Queen Margaret University, 2015. https://eresearch.qmu.ac.uk/handle/20.500.12289/7728.

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Background: Chronic pain is a prevalent healthcare problem which influences each aspect of an individual’s life. A biopsychosocial approach is the dominant one to be taken in the understanding and treatment of chronic pain as not only physical but also psychological factors influence the pain experience. Multi-disciplinary interventions based on a biopsychosocial approach provide an effective treatment strategy for the management of chronic pain. However, the availability of these interventions is limited. Research indicates that internet-based self-management interventions can address this limitation. Aim: The aim of this study was to assess the effectiveness of an internet-based pain self-management intervention, for individuals with chronic pain that were recruited from various clinical settings. The intervention is a well-known pain self-management website known as the ‘pain toolkit’. This is the first study that we are aware of which examines the effectiveness of the ‘pain toolkit’ intervention in a ‘real-world’ clinical context. It was hypothesised that the participants’ fear of movement/(re)injury, pain-related anxiety, pain catastrophizing, pain (intensity and interference) and passive coping strategies (i.e. diverting attention, catastrophizing, praying/hoping) would decrease after engagement with the ‘pain toolkit’ website. Moreover, it was hypothesised that the participants’ self-efficacy and active coping strategies (i.e. reinterpreting pain sensations, coping self-statements, ignoring pain sensations, increasing activity level, the ability to decrease pain and to control pain) would increase after engagement with the ‘pain toolkit’ website. Finally, it was hypothesised that the participants’ readiness to engage in pain self-management would increase from the onset to the completion of the intervention. Specifically, engagement with the ‘pain toolkit’ intervention would facilitate participants’ movement into a more advanced stage of pain self-management. Methodology: Self-report questionnaires, including: Pain Stage of Change Questionnaire (PSOCQ), Tampa Scale for Kinesiophobia (TSK), Pain Anxiety Symptoms Scale (PASS), Brief Pain Inventory (Short-Form: BPI), Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire (PSEQ) and Coping Strategies Questionnaire (CSQ) were completed by the participants - both before and after the intervention. Participants engaged with the intervention for 6 weeks. Results: Forty-eight chronic pain patients (27 females and 21 males) aged 22 to 77 completed the study. Participants showed significant reductions in pain related anxiety, fear of movement/(re)injury, and pain catastrophizing and there was significant improvement in their ability to decrease pain. Conclusion: These findings indicate that internet-based, pain self-management intervention, such as the ‘pain toolkit’ is an effective intervention on a variety of measures for individuals living with chronic pain.

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Bemis, Lola, Bonita Harper, and Sima Molla-Hosseini. "Self-Management Strategies for Chronic Pain Reported in Population-Based Surveys: A Systematic Review." The University of Arizona, 2017. http://hdl.handle.net/10150/624027.

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Class of 2017 Abstract
Objectives: The purpose of this systematic review was to identify the types of management strategies reported by individuals with chronic pain to manage chronic pain, the average number of strategies used, outcomes, and side effects. Methods: To be included in the systematic review, reports of population surveys of adult patients with chronic pain, as defined by the authors, had to be published in English, include chronic pain from any cause, and include information on the treatment strategies used by respondents. Search terms included “pain,” “self-care,” “self management,” “self treatment,” and “adult” and the search strategy included systematic searches of Pubmed, Embase, Cochrane Library, PsycINFO, CINAHL, Web of Science, International Pharmaceutical Abstracts, searches of reference lists, and citation searches as well as key websites such as the CDC and NIH. Results: A total of 13 study reports were identified. Sample size ranged from 103 to 4839; mean age ranged from 42 to 81 and 51 to 69% female. All reports included information on medications used to manage pain; 6 reported other medical strategies; 9 reported physical strategies; 6 reported psychological strategies; and 11 reported non- medical strategies. Only 4 studies reported some data on the number of strategies used; one study reported 23% used 6 or more medications, another reported 51% used 3 or more strategies. Six studies reported some type of outcome; including inadequate control of pain (40%) or good relief (87%), and 36% as effective in a third study. Few side effects were reported; two studies reported constipation, nausea and vomiting. Conclusions: Population-based surveys of chronic pain have identified a large number of strategies used to manage pain, however they provide little information on the average number of strategies used, the effectiveness of the strategies, or resulting side effects.

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Morden, Andrew William. "Exploring 'risk' and self-management in relation to chronic joint pain." Thesis, Keele University, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.602981.

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Chronic joint pain, specifically knee pain, is a prevalent disabling chronic condition. Policy and clinical guidelines promote education of risk factors and supported self-management to ameliorate predicted demands upon state, society and the individual. Extant literature offers little insight into if and how 'risk' is understood in relation to chronic joint pain. The broad research questions in this thesis ask: do people have knowledge of risk factors for joint pain? How do people conceptualise or experience risk in relation to joint pain? How does risk relate to self-management? Qualitative methodology is used within this study. An interpretive approach is used to explore and understand participants sense making and experiences in relation to the concept of risk. Fifteen participants took part in two in-depth interviews spaced six months apart. Eight of the participants also took part in a diary study between the interviews. Findings reveal that lay explanations about jOint pain, lived experiences of illness, meaning making about the body and subsequent learned strategies to deal with joint pain mirror clinical perspectives of 'risk'. People with joint pain encounter 'risk' as a threat to biography or as hazardous scenarios related to their social environment. Self-management of symptoms is mediated by subjective and socio-contextual factors relating to embodied experiences of pain and lay sense making about how physiology interacts with motion and weight loss. Self-management in relation to 'risk' is about managing threats to self, obligations to others, and hazardous scenarios as well as symptom control. New insights for understanding risk are suggested, taking into account the epistemological, ontological and material elements of people's lives with chronic joint pain.

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Buck, Rhiannon. "Naturally occurring attentional strategies in the self-management of cancer pain." Thesis, University of Leeds, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.410931.

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Adem, Ahmed. "Exploring self-management of chronic low back pain in Saudi Arabia." Thesis, Sheffield Hallam University, 2017. http://shura.shu.ac.uk/19155/.

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Aim: The main purpose of this research project is to explore both patients’ and physiotherapists’ perceptions and understanding of self-management for chronic low back pain (CLBP) in the Kingdom of Saudi Arabia (KSA) and moreover, to explore current physiotherapy practice for managing CLBP in KSA. Methods: This research project used a mixed methods approach with sequential designs. The first section contains a quantitative study and the second section includes two qualitative studies. The quantitative section allowed exploration of current physiotherapy practices for CLBP management using a large population. The qualitative section has provided a more in-depth understanding of both patients' and physiotherapists' perceptions in regards to self-management and physiotherapy management for CLBP. Results: In the current study, physiotherapists acknowledged the importance of exercise and advice. Moreover, these represented the most common treatment methods used in daily practice. However, patients’ preferences for passive approaches, such as rest, massage and modalities were frequently reported. This shows conflict between physiotherapists and patients with CLBP in terms of the preferred approach for managing the disorder. Physiotherapists’ extensive use of modalities where evidence of effectiveness was lacking or insufficient was a common practice for physiotherapy management in patients with CLBP in the current research project. Moreover, physiotherapists and patients showed limited understanding of self-management as a concept. Conclusion: Promoting self-management in daily physiotherapy practice appears to be a complex issue. It involves various factors, such as promoting an evidence-based practice culture among physiotherapists; a patient-centred approach; access to guidelines and evidence; and organisational support through developing policy, local guidelines and CPD training. This research presents a platform of recommendations for future researchers, professionals, educators and policymakers to enhance the quality of care for patients with CLBP in the KSA in general and may increase the adoption of self-management.

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Liang, Shu-Yuan. "Opioid-taking self-efficacy in Taiwanese Outpatients with cancer pain." Queensland University of Technology, 2007. http://eprints.qut.edu.au/16516/.

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Despite the fact that as many as 80-90% of patients with cancer pain can be effectively treated using pharmacological therapies and other advanced approaches, 31% to 85% of cancer patients in Taiwan still experience varying levels of pain. Pain is one of the symptoms that patients fear most; it overwhelms all aspects of patients' lives and creates a sense of uncertainly and hopelessness. Pain control is, therefore, a high priority in the treatment of cancer patients. Pharmacological therapy is the cornerstone of cancer pain management. With the current trend toward outpatient care, many patients are being required to assume greater responsibility for self-management of prescribed analgesics at home to deal with the variable and complex nature of cancer pain and side effects of opioids. Patients however, have misconceptions regarding analgesics and a series of difficulties when attempting to put a pain management regimen into practice. This research addressed the hypothesis that self-efficacy beliefs might play an important role in analgesic adherence and pain experience in Taiwanese outpatients with cancer. The purpose of this study was to develop a scale to measure the self-efficacy expectations relating to opioid-taking in Taiwanese outpatients with cancer. Another purpose was to explore how opioid-taking self-efficacy and beliefs about opioid analgesics contribute to patients' analgesic adherence and pain experience in Taiwanese outpatients with cancer. In the first stage semi-structured interviews were conducted to collect data from a purposeful sample (n=10) of oncology outpatients from two teaching hospitals in the Taipei area of Taiwan. The purpose of this phase was to identify behaviours and situational impediments associated with analgesic taking. Findings from this phase were used to develop a scale to measure opioid-taking self-efficacy. In the second stage a pilot test with a convenience sample (n=30) was conducted to test the validity and reliability of the new scale and to identify the feasibility of using the scale in a cross-sectional survey. In the third stage a cross-sectional survey was undertaken (n=92) to describe pain experiences, analgesic adherence, beliefs about opioid analgesics, and opioid-taking self-efficacy in Taiwanese outpatients with cancer and to explore how opioid-taking self-efficacy and beliefs about opioid analgesics contributed to analgesic adherence and pain experience. Results of this study highlight an important issue - under-treatment of cancer pain in this group of Taiwanese outpatients. As well, low adherence rates to opioid analgesics in cancer outpatients arose as an important issue in this study. A range of misconceptions about using opioids for pain was also common amongst the sample. Despite these misconceptions, patients reported being moderately confident in their ability to perform self-management behaviours related to their prescribed opioid-taking. Results of this research supported the notion that patients' self-efficacy in relation to taking their prescribed opioid regimen was a significant independent predictor of patients' adherence behaviour and pain relief, but not of pain severity. Beliefs about opioid analgesics were also an independent predictor of patients' adherence, but not of pain relief or pain severity. In addition, findings from this study provided support for the validity and reliability of the opioid-taking self-efficacy scale. Results suggested there is a need for systematic assessment of beliefs affecting patients' opioid adherence behaviours for cancer pain control, including perceived personal self-efficacy and beliefs about opioid analgesics. Educational programs that focus on overcoming patients' misconceptions (beliefs) about taking opioid analgesics may be particularly beneficial. In addition, this study advocates that conducting self-efficacy-enhancing interventions may improve medication adherence for patients and therefore pain relief. More research is needed to demonstrate the construct validity of the self-efficacy scale and to evaluate self-efficacy enhancing interventions in cancer pain management.

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Chavez, Ramon, Daniel Trinh, and de Dios Daniel Vergel. "Strategies Used by Pharmacists for the Self-Management of Acute and Chronic Pain: An On-Line Survey." The University of Arizona, 2017. http://hdl.handle.net/10150/624165.

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Class of 2017 Abstract
Objectives: Specific Aim 1: Pharmacist will use pharmacological pain self-management strategies over non- pharmacological strategies. Specific Aim 2: Pharmacist pain self-management strategies will differ based on whether or not the pharmacist has chronic pain. Specific Aim 3: Pharmacist pain self-management strategies will differ across age. Specific Aim 4: Pharmacist pain self-management strategies will differ across gender. Methods: A survey was sent to all pharmacists with an email address registered with the State Board of Pharmacy in a single Southwestern state. The survey asked about characteristics of pain, strategies for managing pain, outcomes, and demographics. The primary outcome was severity of pain after treatment. Results: Responses were received from 417 pharmacists; 219 reported acute, 206 reported chronic pain, and 55 reported no pain. The chronic pain group was more likely to have a disability with poor/fair health status (P<0.006) and to report higher levels of pain before treatment (6.9 versus 5.8). Both groups reported similar relief from all strategies (76% versus 78% ; P equals 0.397), but the chronic pain group reported higher levels of pain after treatment (3.2 versus 2.0), less confidence in pain management, and less satisfaction (P less than 0.004). Conclusions: Age and gender did not affect the use of specific pain management strategies or the amount of pain relief received from all strategies used by participants with either acute or chronic pain. However, participants with chronic pain had higher levels of pain before and after treatment.

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Samuel-Ojo, Catherine Olubunmi. "The Influence of Pain Self-Management Education on the Prevalence of Opioid Prescription among Patients with Chronic Non-Cancer Pain: An Agent-Based Modeling Simulation." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/594392.

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Chronic pain has no cure. It is a lifelong condition presenting a growing concern due to its high occurrence and effects on every facet of life. It cost about $635 billion each year in medical treatment and lost productivity (IOM, 2011). The management of chronic pain using prescription painkiller opioids has increased drastically in the last two decades, leading to a consequential increase in deaths from chronic opioid use. This Plan-Do-Study-Act quality improvement project investigates the problem of the prevalence of opioid prescription using agent-based computational modeling method. The simulation models the interaction of 50 patient-agents with pain self-management messages in an episode of 50 patient iterations (visits) for 10 simulated years. This interaction generates health benefit and risk outcomes represented by wellness data obtained when messages are processed. As the simulation runs, data are dynamically captured and visualized using wellness charts, time series plots, and benefit and risk regression plots. The result of the project provides evidence for research and practice on the process of achieving more impact of programs based on administering pain self-management education to patients with chronic non-cancer pain who are currently on opioid therapy and on the process of customizing interventions that might take advantage of the conditions of behavior change driven by pain self-management messages. The tools and the evidences in this project are highly recommended to nurse practitioners primary care providers involve with providing care to the vulnerable groups of patient with chronic non-cancer pain. These evidences might inform the formation of self-management interventions that might lead to a decline in opioid use and prescription and accelerate the acceptance of self-management practices.

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Matthie, Nadine. "Sickle Cell Disease: The Role of Self-Care Management." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4538.

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Abstract Sickle cell disease is the most common genetic disorder in the United States. Approximately 90% of the hospitalizations in this patient population occur due to the most common complication, pain crises. Prevention of these crises is therefore essential and requires the patient to assume an active role in his or her disease management. Studies suggest that further research is needed to examine the self-care management process and to identify factors influencing self-care behaviors. The relationships among these factors must be clearly defined before interventions to improve self-care management can be determined. The aims of the study were threefold. The first aim was to evaluate the relationships among psychosocial variables (SCD self-efficacy and social support) and socio-demographic variables (age, gender, education, employment status, income, and living situation) in understanding individual differences in self-care management variables (perceived self-care ability and self-care actions). It was hypothesized that higher SCD self-efficacy, greater social support, being employed, living with family or friends, increased age, more years of education, higher income, and being male are each associated with having higher perceived self-care ability and more frequent self-care actions. The second aim was to evaluate the relationships among psychosocial variables (SCD self-efficacy and social support), socio-demographic variables (age, gender, education, employment status, income, and living situation), and self-care management variables (perceived self-care ability and self-care actions) in understanding hospital visits for crises. It was hypothesized that higher perceived self-care ability and more frequent self-care actions are associated with fewer hospital visits for crises. The third aim was to evaluate the mediational role of perceived self-care ability and self-care actions in the relationships among psychosocial variables (SCD self-efficacy and social support), socio-demographic variables (age, gender, education, employment status, income, and living situation), and the number of hospital visits for crises. It was hypothesized that SCD self-efficacy, social support, and the socio-demographic variables have both a direct and an indirect relationship with the number of hospital visits for crises. In 103 young Black adults (ages 18-30) with sickle cell disease (SCD), an exploratory , correlational study was conducted, via secondary analysis of data, to examine the relationships among SCD self-efficacy, social support, socio-demographic variables, self-care management (self-care ability and self-care actions), and the number of hospital visits for crises. Bivariate correlations and regression analyses were conducted to evaluate the relationships among the variables and to examine the mediational role of self-care management. Sickle cell disease self-efficacy, social support, years of education, and income were significantly related to perceived self-care ability and self-care actions. Social support accounted for the majority of the variance in each self-care management variable. The hypothesis that higher SCD self-efficacy and greater social support are associated with higher perceived self-care ability and more frequent self-care actions was supported. Education was also associated with higher perceived self-care ability and self-care actions as hypothesized. The overall model with SCD self-efficacy, social support, years of education, income, perceived self-care ability, and self-care actions was not significant in predicting the number of hospital visits for crises. There were no significant associations noted among age, annual household income, living situation, employment status, and the self-care management variables. The hypothesis that higher perceived self-care ability and more frequent self-care actions are associated with fewer hospital visits for crises was not supported. Further, there was no adequate evidence to support a direct relationship between SCD self-efficacy, social support, years of education, and the number of hospital visits for crises. The indirect relationship, through self-care management, among the variables was also non-significant. There was however a significant direct relationship noted between income and the number of hospital visits for crises. The outcomes of the study may be important for clinical care, patient education, and health outcomes in the SCD population. Findings may be used to conduct larger confirmatory studies and to develop interventions that may be used to supplement therapy in the clinical setting and to enhance patient self-care management at home. Additional studies are needed, however, to clarify what additional variables may affect the number of hospital visits for crises and to identify specific pain prevention and management strategies used by SCD patients.

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Robertson, Ann R. R. "Self help and the early management of acute, non-specific low back pain." Thesis, Queen Margaret University, 2008. https://eresearch.qmu.ac.uk/handle/20.500.12289/7348.

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This research investigated whether there might be benefit from encouraging early self management in an episode of non-specific low back – a common and costly condition in the U.K. It aimed to address a lack of research evidence on interventions to improve current, Step 1 of primary care management for back pain. A self help, audio programme, to give information and reassurance about non-specific back pain and skills training in some components of cognitive behavioural pain management, could be used independently at home. Self help could widen access to early, cognitive behavioural based treatment, might offer an inexpensive and practicable means of intervention delivery in busy GP practices and would accord with government policy of encouraging increased self management by NHS patients. Pilot evaluation: The face validity of two, self help, audio CD programmes for use at home, “Using Relaxation Skills” and “Using Thinking Skills”, was assessed by six primary care patients with nonspecific, acute low back pain. Participants in the pilot evaluation expressed some satisfaction with both self help programmes and found them helpful. The audio CD with a focus on progressive muscular relaxation, “Using Relaxation Skills”, was more popular. Pragmatic randomised controlled trial of self help CD effectiveness: The primary objective was to demonstrate whether using a three week, self help programme at home showed benefits with respect to back pain specific functioning as measured by the Roland and Morris Disability Questionnaire (RDQ). Forty four members of the public with a current episode of back pain lasting between two and nine weeks were randomised to a CD intervention arm or a control arm. Back pain specific functioning, self reported pain intensity and general health and well being in physical and mental domains were assessed at baseline and at one and six months' follow up. Data analysis conducted using a mixed between-within subjects analysis of variance demonstrated significant improvement across all measures over time for all participants. Compared to controls, those using a self help, audio CD showed significantly improved scores on the RDQ at six months [F =6.673, p=.013], although the magnitude of the mean group difference was small (partial eta squared=.137). It is concluded that a three week, home based self help programme delivered by audio CD can improve functional outcomes in the short to medium term in early, non-specific low back pain. Interpretative Phenomenological Analysis (IPA) of self help for back pain: The study aimed to explore possible reasons for the slow uptake by the public of a free, self help CD for early back pain. Nine people with non-specific low back pain were interviewed by email to explore their experiences of using self help for managing pain. An IPA analysis revealed four, major themes: taking control, social comparisons, ongoing learning and “with hindsight”. The findings suggest that turning to self help for back pain may be a developmental process over time, related to the variable course of back pain symptoms. Interviewees wished with hindsight they had been directed towards self management in the initial stages of back pain. At the time of first consulting a GP, they had hoped for a medical “cure”. The findings indicated that slow recruitment into a self help intervention for early low back pain may reflect a lack of perceived need for any intervention in the initial phase of the condition, with implications for the likely uptake of an early, self help intervention.

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Akintan, Oyesola Omowunmi. "Practice Guidelines for Self-Management of Osteoarthritis Pain in the Home-Based Settings." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/209.

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Osteoarthritis (OA) is a debilitating chronic illness that can prevent older adults from accomplishing their activities of daily living or ambulate without pain. The project's purpose was to develop and disseminate multidisciplinary educational practice guidelines to nurses for use in older homebound male Veteran's Administration OA patients to improve home-based pain management and self-care preventative strategies. Orem's theory of self-care management constituted the theoretical framework. The design was a quality improvement project and involved formation of 6 panels of interdisciplinary teams who reviewed the American Society of Anesthesiologist (ASA) and Osteoarthritis Research Society International (OARSI) guidelines. The ASA and OARSI guideline components were evaluated via a scoring sheet for pain control and self-management effectiveness for the OA patient. The panels assessed these treatment plans in terms of suitability, tolerance, and patient adherence for inclusion into the educational program. The panel members independently reviewed both sets of guidelines and then convened as a group to share their scores and reach a consensus on these guidelines, in the patient population served. Agreement of 85% among the panel members was needed for inclusion into the practice guideline. Based on the scoring results the panel concluded that the ASA and OARSI guidelines would likely improve pain control, functional ability, and psychological well-being essential to lifestyle modifications and OA symptoms management education program. The social impact of developing nursing practice guidelines for the self-management of OA pain in home-based settings will be manifested in better patient lifestyle and behavior modification leading to better symptom management.

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Moran, Monica. "The impact of a home based education and self management programme for patients with chronic back pain after completion of a multidisciplinary pain management programme /." St. Lucia, Qld, 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16743.pdf.

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Booker, Staja Quinae. "Help for Osteoarthritis Pain in African American Elders (HOPE): patterns, predictors, and preferences of osteoarthritis and chronic joint pain self-management." Diss., University of Iowa, 2017. https://ir.uiowa.edu/etd/5719.

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Introduction: Chronic joint (CJ) pain is the foremost osteoarthritis (OA) symptom that affects older African Americans’ (AAs) functional ability. Every effort should be made to reduce the development of high-impact chronic pain. One way to effectively do this is for older AAs to consistently engage in self-management utilizing the recommended OA treatments. Recommended behaviors include land-based exercise, water-based exercise, strength (muscle and endurance) training and stretching, self-management education, analgesic medications, thermal (warm/cool) modalities, and use of assistive and/or orthotic devices. However, evidence suggests these core behaviors of chronic pain self-management are not optimally utilized in older AAs. Methods: A convergent, parallel mixed-methods study explored patterns, preferences, and predictors of stage of engagement (pre-contemplation, preparation, or action) in recommended OA and CJ self-management behaviors. One hundred ten AAs aged 50 and older from communities in north Louisiana completed quantitative surveys, and a subset of 18 participated in audio-recorded qualitative interviews. Using SPSS, multinomial and binomial regression were used to build predictive models to determine which contextual and cognitive factors predict stage of engagement in each recommended and complementary OA self-management behaviors. A qualitative descriptive approach underscored a conventional content analysis of qualitative data. Results: Older AAs were “dealin’ with it [pain]” in a variety of ways, and their experience of having OA and CJ pain was based on their ability and willingness to bear the pain, understand the nature of OA pain, and experience life with daily pain. These dimensions of dealin’ with pain acted as a catalyst for engagement in complementary and recommended behaviors. In addition, participants’ and providers’ cultural receptivity may limit or enable engagement in certain recommended evidence-based OA behaviors. Specifically, each recommended OA self-management behavior was associated with different predictors of engagement. Confidence to manage pain was a predictor for land-based exercise, while there were no factors associated with water-based exercise. The most reasonable explanation for this finding of lack of participation in water-based exercise is likely due to inability to swim and lack of access to a personal or community pool. Engagement in strength training was significantly associated with confidence, knowledge of strength training recommendation, motivation, pain interference, and spirituality. For self-management education, only knowledge of self-management education recommendation was a predictor. Most AA older adults were unaware that this was recommended or didn’t have access to a self-management program; subsequently the majority had never participated in such but were in the preparation stage. Predictors for medication use included confidence, knowledge, and pain interference. Almost all AAs were using either over-the-counter or prescribed medications. Use of thermal modalities was predicted by pain interference. Lastly, using assistive and/or orthotic devices was significantly associated with employment status, OA pain severity, pain interference, and perceived social support. Assistive and/or orthotic device use was evenly split between users and non-users. Pain interference emerged as the most salient factor predicting stage of engagement in any of the recommended behaviors. Depending on the specific behaviors, pain interference prevented or motivated engagement. Conclusion: OA and CJ pain is a significant symptom in older AAs. This study’s mixed method approach uncovered what older AAs do to manage pain. More specifically, these results illuminate the daily patterns and preferences for self-management. We identified specific barriers and motivators that influence engagement in OA self-management behaviors, and determined the most relevant predictors for each stage of engagement. In addition, we were able to develop a model of OA and CJ pain self-management based on the predictors.

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Oduah, Chukwudi. "Chronic Low Back Pain- A Needs Assessment for Practice Change." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4666.

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There is a practice gap in the self-management education of patients with chronic low back pain. Insufficient self-management leads to increased frequency of flare-ups of low back pain, disability, loss of productivity, and increased cost of health care. The guiding practice-focused question was focused on the unmet self-management support needs of the chronic low back pain patients in a Midwestern state local pain clinic. The purpose of this descriptive cross-sectional study was to ascertain the unmet needs of patients' self-management support by analyzing the results of a patient study performed by this clinic. The theoretical principles of the model for evidence-based practice change, the chronic care model, and the middle-range theory of self-care of chronic illness were used. The evidence included the analysis of the Patient Assessment of Chronic Illness Care Survey (PACIC) data from 100 patients treated in this pain clinic. The clinic used the PACIC questionnaire to collect data from its 100 chronic low back pain patients, selected by simple random sampling method. The average weighted scores of these patients' responses were below the norm on all PACIC subscales and summary scores. According to study results, this pain clinic did not meet the self-management support needs of its chronic low back pain patients. Evidence-based recommendations were made for the improvement in the medical model of patient care by including nurse-led patient education and support. The positive social change is the improvement in the health status of this growing health population by meeting their identified education and support needs. Positive results from this nurse-led intervention could lead to the dissemination and widespread implementation of these recommendations in other pain clinics.

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Gustavsson, Catharina. "Self-management of Persistent Neck Pain : A Multi-component Group Intervention in Primary Health Care." Doctoral thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-134522.

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The overall aim of this thesis was to evaluate effects of a multi-component pain and stress self-management group intervention (PASS) and to explore plausible predictors associated with short-term and long-term treatment effects among patients with persistent tension-type neck pain in primary health care (PHC). Study I was a pilot study in order to explore feasibility of the study design and methods. It included 37 participants randomly assigned to the intervention (n=18) or treatment-as-usual (n=19). Study II-III was a pragmatic randomized controlled trial that compared effects of the PASS and individually administered physiotherapy (IAPT) on patients with persistent tension-type neck pain in PHC. Study II evaluated short-term effects over a 20-week follow-up. Study III evaluated long-term effects on maintenance over a follow-up period of 2 years. Studies included 156 participants randomly assigned to PASS (n=77) or IAPT (n=79). Study IV explored predictive factors for favorable outcome in disability regarding participants assigned to PASS. The results showed that PASS had better effects than IAPT regarding coping with pain, in terms of patients’ ability to control pain, self-efficacy regarding activities interfered with by pain, disability and catastrophizing, over the 20-week follow-up, and treatment effects were largely maintained over a 2-year follow-up. Post-treatment scores in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability 2 years post-treatment following PASS. Pre-treatment characteristics explained only a minor proportion of variance in disability, and were assumed weakly associated with treatment success and long-term outcome. Key components for enhancement of long-term efficacy in pain self-management coping efforts were adequately targeted by PASS. It is suggested important to strengthen self-efficacy beliefs in regard to pain coping, to reduce disability and enhance pain self-management in the treatment of persistent neck pain, and to induce long-term maintenance of treatment gains on disability following a pain self-management intervention.

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Gold, Ann. "Control cognitions in pain management group programme participants : locus of control versus self efficacy beliefs." Thesis, University of Surrey, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.248068.

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Assefa, Metasebia. "Evaluating the Effectiveness of Registered Nurse-led Chronic Pain Self-Management Program within a Primary Care Facility." Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39074.

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Self-management support (SMS) is considered an effective approach to chronic pain (CP) management. However, the provision of SMS for chronic pain patients faces challenges within primary care facilities in Ontario. An innovative SMS program led by a Registered Nurse (RN) at the Bruyère Family Health Team in Ottawa has been created for chronic pain patients. The goal of this program is to improve the current chronic pain management using SMS in an outpatient facility by harnessing the skills of primary health care team members. The hope would be that this program could be spread and scaled across other programs in the region. This thesis exists in two parts: 1. Evaluate the RN-led chronic pain self-management program to determine its effectiveness in terms of self-reported pain scales and Morphine Equivalence Quotient (MEQ) 2. Understand the perspectives of health care practitioners, administrators and patients within the RN-led chronic pain self-management program Patients meet with the RN for initial face-to-face visit for an hour, for SMS and then for at least one follow up visit. The primary outcome variables of interest were their self-reported pain evaluated using validated pain scales. Opioid use was also assessed before and after the porgram based on the MEQ. Results were analyzed using SPSSversion20. An online questionnair was distributed to team members. All responses were conceptually arranged into a SWOT analysis, which will be directed toward the ongoing management needs of the clinic. Between January 2016 and August 2018, 125 patients were seen of these 58 patients (12 males and 46 females) had at least one follow up appointment with the RN. In 46.2% of the population there was a decrease in their total opioid dose from their first to their last appointment and of these 4 patients (15.4%) had a daily MEQ of 0 by their last appointment. There was a significant average difference between patient’s daily MEQs at their first and last appointment (t20= 2.245, p<0.05). On average patients came into their first appointment with a daily MEQ of 23.88 higher than at their last visit (95% CI [1.69, 46.07]). Staff and patients who participated in the online survey identified the following strengths: multidisciplinary approach, increased accessibility for patients, cost effectiveness, better patient engagement, and no refills of opioids Canada needs a better strategy to manage the CP epidemic. This chronic pain self-management program led by an RN focuses on a multidisciplinary approach that is readily accessible to patients and integrated within primary care to best meet and prioritize the needs of chronic pain patients.

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Kiser, Connie Hutley. "Impact of Osteoarthritis Self-Efficacy Toolkit on Adults with Osteoarthritis." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3617.

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Over 26 million U.S. citizens have a form of arthritis; osteoarthritis (OA) is the most common form. Self-efficacy (SE) is defined as a psychological construct which identifies an individual's confidence when performing a behavior. SE is deemed a vital judge of self-management (SM) in those with OA. The purpose of this evidence-based practice, quality improvement project was to improve SE in OA patients. The identified gap in nursing practice was the lack of SE in OA patients. The project question asked whether a toolkit with information regarding SE in OA can improve SE of management of disease-associated symptoms in adults with OA as evidenced by improved Arthritis Self-Efficacy Scale (ASES) scores pre- to post-program. Concepts and theory used to inform the doctoral project were SE, pain, SM and OA, and Bandura's theory of SE. The sources of evidence were obtained from a variety of peer-reviewed journals related to OA management, and the outcome was measured using the ASES. Thirty-five participants (16 males and 19 females) with a mean age of 62 from a physical medicine and rehabilitation clinic in San Antonio, Texas participated in the project. The National Institute of Arthritis and Musculoskeletal and Skin Disorders 2015 Handout on Health: OA was used as the SE OA toolkit. Mean scores from pre- and post-program were tabulated and compared to determine the outcome. Results showed improved ASES levels by 11.84%. Implications for nursing practice and positive social change include the enhancement of SE levels, which can improve compliance in SM by use of a toolkit and further as policy implementation for OA patients to improve SE and SM abilities.

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Axon, David Rhys, and David Rhys Axon. "Development and Validation of a Tool to Calculate an Exposure Score for All Pain Self-Management Strategies Used By Individuals with Chronic Pain." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/626341.

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Objectives: To develop a tool to calculate the exposure scores for all pain self-management strategies used by individuals with chronic pain, and to test the validity of the tool by assessing associations between exposure and pain outcomes using regression. Methods: Survey data of pharmacists’ pain self-management strategies were used to calculate the exposure score. One point was assigned for every: 100mg of morphine used (opioid medications); 25% of the maximum recommended dose used (non-opioid medications); and any use of another strategy. Points were summed to calculate each individual’s exposure. Regressions assessed associations between exposure and pain outcomes. Results: Data for 149 individuals with chronic pain were included in the study. Individuals with chronic pain used a mean of 12.7 (SD=4.7) strategies to manage their pain, and had a mean exposure score of 16.8 (SD=9.1). Exposure score was positively associated in the multivariate models with the self-reported pain outcomes: adverse events experienced due to pain; workdays lost in the last six months due to pain; and pain interference on relationships (p<0.05). Conclusions: This validity study showed positive associations between the exposure score calculated by our tool, and adverse events experienced due to pain, workdays lost in the last six months due to pain, and pain interference with relationships. The personalized exposure profile produced by the tool may assist patients and providers when determining the most appropriate pain self-management strategies to use.

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Löf, Emma, and Madeleine Olsson. "Att leva med endometrios : en litteraturstudie." Thesis, Högskolan Väst, Avdelningen för omvårdnad - grundnivå, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-13487.

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Background: Endometriosis is an estrogen-dependent disease which means that the uterine mucosa grows outside the uterine cavity. The disease causes women' pain and affects the quality of life and it takes an average of five to seven years to get the diagnosis established. Aim: The aim of this study was to illustrate women's exeperiences of living with endometriosis. Method: This is a literature study where method to contribute to evidence-based nursing based on analysis of qualitative research was used. Results: Findings in the study showed that women with endometriosis experienced limitations in their daily life. Pain was the most described symptom and women experienced lack of knowledge of themselves and by their surroundings. They risked being misstrusted because of normalization of the symptoms. The women developed strategies to take back control over their lives which helped them to master the disease. Conclusion: In order to provide advice and support, the nurse needs increased knowledge about endometriosis and how it affects the women's lives. It would also reduce the time of delayed diagnosis.
Kvinnor som lever med endometrios kan komma att behöva strukturera om sina liv då deras vardag begränsas. Somliga kvinnorna får inte gehör av den sociala omkretsen och hälso- och sjukvården för de symtom de upplever. För att återfå kontroll över livet utvecklar kvinnorna strategier i hopp om att bemästra sjukdomen. Denna litteraturstudie belyser kvinnors upplevelser av att leva med endometrios. Var tionde kvinna i fertil ålder drabbas av endometrios och sjukdomen är förknippad med sänkt livskvalitet där både kroppslig och psykisk belastning förekommer. I resultatet framkommer att det råder kunskapsluckor om endometrios hos både kvinnan och hälso- och sjukvården. Kvinnorna riskerar att inte bli trodda på då sjukdomen för andra inte är visuellt synlig. De symtomen kvinnan upplever och uttrycker sig om normaliseras i somliga fall av henne själv och hennes omgivning, då symtomen främst syftar till smärta i samband med menstruation. Kunskapsluckor i relation med normalisering av symtomen kan vara en orsak till försening av diagnos och kvinnan utsätts för ett långt vårdförlopp och försämrad livskvalitet. Förmågan att arbeta påverkas och kvinnan kan komma att vara i behov av vila och återhämtning. Ökad frånvaro leder till att kvinnan oroas över att förlora arbetet, då arbetsgivare och kollegor inte alltid tror på de symtom de beskriver. Även samlivet påverkas. På grund av försämrad sexuell funktion och smärtupplevelser vid samlag undviker kvinnor relationer. Kvinnorna oroas över sin fertilitet och risken för infertilitet i framtiden och de kan komma att bli lämnade av sin partner på grund av diagnosen endometrios eller infertilitet. Endometrios kan få kvinnan att känna sig mindre kvinnlig. Med hjälp av utvecklade strategier återfås kontroll över vardagen. Strategierna ses som styrkande och kvinnan blir mer lyhörd på sin kropp med ökar sitt ansvar för den egna hälsan. Att bemästra sjukdomen hjälper kvinnorna att se på sina kroppar utifrån positiva vinklar och upplevelserna kunde de dela med sig av till andra.

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Monaghan, Jenni. "Experiences and perspectives of self-management for low back pain in clinical practice : implications for support and education." Thesis, Northumbria University, 2015. http://nrl.northumbria.ac.uk/28953/.

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Pain is multidimensional and self-management is advocated to manage the biopsychosocial impact of this on individuals’ lives. Thus, these individuals’ perspectives regarding self-management have been explored. This study aimed to firstly explore how self-management was understood in the context of low back pain through the experiences of people living with low back pain and physiotherapists’. This then led to informing the development of an education programme for physiotherapists to support self-management. The study used a mixed method approach, which involved three phases being carried out over a period of time with each informing the subsequent phase. Phase 1, a qualitative synthesis examined primary qualitative research focusing on people living with low back pain and physiotherapist experiences of self-management of low back pain. The synthesis informed phase 2, two qualitative studies addressing areas of paucity found within the literature. The final phase, a feasibility study involved the development of an education programme for physiotherapists who completed pre and post outcome measures. Focus groups were also used in evaluating the intervention. The qualitative synthesis revealed a limited amount of literature regarding physiotherapists’ views and experiences of self-management of low back pain. A large proportion of studies that related to physiotherapy focusing on people living with low back pain experiences of self-management concentrated on strategies, in particular exercise with limited relation of this to daily life. The primary qualitative studies highlighted some difficulties physiotherapists faced when supporting the management of the biopsychosocial impact of LBP. Further, at times self-management could be used as a last resort. In relation to this, half of the people interviewed living with low back pain found this to be restricting their daily activities and were fearful and concerned regarding worsening pain in the future. These findings suggested people were not managing the biopsychosocial impact of low back pain and physiotherapists at times viewed influences on the pain experience as separate rather than integrated. Pain neurophysiology education linked to clinical practice was used to demonstrate the integrated nature of the pain experience, be relevant to physiotherapists and ultimately facilitate biopsychosocial self-management through enhancing understanding of the multidimensional nature of pain. Collectively, this thesis has developed understanding of self-management from the physiotherapist perspective, illuminating the support required for physiotherapists and revealed physiotherapists value pain neurophysiology education linked to practice however further support is required to implement this in clinical practice.

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Yothathai, T. "Self-management for pain control in Thai patients who have cervical cancer in a Thai Regional Care Centre." Thesis, University of Southampton, 2014. https://eprints.soton.ac.uk/379618/.

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Cervical cancer is one of the most common cancers in Thailand with around 10% of these women experiencing persistent pain. One third of those are under treated and it is claimed that programmes of self-management may contribute to better managing this pain. However, self-management is a Western concept and it is not clear whether this concept is helpful to Thai people or how it might be conceptualised or how Thai people self-manage their pain. The aim of this study to explore the way in which Thai women with cervical cancer manage their pain with specific reference to the potential for self-management in hospital and at home and how they might be supported in this activity by their family and health professionals. A single embedded case study design was adopted over six months in a regional cancer centre located in the North-East of Thailand. The participants were purposively sampled for the phenomenon under investigation. Six patients with cervical cancer experiencing moderate to severe pain, six identified family caregivers and seven health care providers were 0interviewed and observed. Framework analysis was used to analyse the observational and interview data. The finding revealed six main themes of self-management including problem solving, decision making, information finding and utilisation, forming patient/health care professionals partnership, taking action and, especially, perception. These themes are influenced by Thai family and culture resulting in a revision self-management model for Thais is developed. The model explains relationship between two main aspects, thinking and behaving that people behave self-management. Thinking and behaving influence each other and can be changeable due to the real situation. Factors influence these two aspects including backgrounds of experience, knowledge, and social context of Thailand. Conclusion, the patients developed their ability to self-manage their pain in their everyday life. To improve self-management in Thai patients, the individual circumstance of family and Thai culture are important factors to be aware.

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Fu, Yu. "The influences of patient-professional partnerships on the self-management of chronic back pain : a mixed methods study." Thesis, University of Leeds, 2015. http://etheses.whiterose.ac.uk/11600/.

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Background: The self-management of chronic back pain may be a lifetime task for many patients. Whereas health professionals are experts in providing health services to support patients, the pain itself and its impact can only be experienced by the patients living with it. It is likely that optimum self-management of chronic back pain may only be achieved when patients and professionals develop a good partnership that integrates their complementary knowledge and skills. Aim: To explore patients' perceptions of the nature and influence of partnerships with health professionals, on their ability to self-manage chronic back pain. There were two objectives: the first was to assess the influence of patient-professional partnerships on patients’ ability to self-manage chronic back pain and to identify any associations between them. The second was to explore patients’ perceptions and experiences of the influence of these partnerships on their self-management ability. Methods: First, a systematic review was conducted to identify research undertaken in this area and to identify key factors within patient-professional partnerships that may influence self-management. Second, an explanatory sequential mixed methods study was undertaken in three pain management clinics in Northern England, UK. Patients were recruited following an initial clinic consultation (baseline) and followed up after three months. The aim of the quantitative phase was to detect changes in outcomes (i.e. PIH, PPiC, BPI, HADS, PSEQ and DoloTest) between the baseline and follow-up data collection. Hierarchical linear regression was used to investigate the association between patient-professional partnerships and the self-management of chronic back pain. A complementary qualitative phase using grounded theory was then conducted through in-depth interviews with a purposive subsample of 26 of the patients from phase one. The aim was to explore patients’ perceptions and experiences of the influence of patient-professional partnerships on their self-management ability. Each interview was transcribed and analysed using constant comparative analysis. Results: Seven themes were identified in the systematic review: communication, mutual understanding, roles of health professionals, information delivery, patients’ involvement, individualised care and health care service. These were developed into a model suggesting how factors within patient–professional partnerships may influence the self-management of chronic back pain. One hundred and three (70.1%) patients completed both baseline and follow-up data collection. Patients’ self-management ability, partnerships with health professionals, pain interference, self-efficacy, general health, and anxiety disorder all showed statistically significant improvement at follow-up. Regression analysis showed that improvements in patient-professional partnerships were positively associated with improvements in pain self-management. In-depth interviews identified a range of facilitators of and barriers to a good patient-professional partnership. Five supportive approaches were provided by health professionals in the pain clinics. Patients’ experiences suggested that a good partnership supported the development of their self-management ability. Conclusion: A good patient-professional partnership appears to have a positive impact on patients’ ability to self-manage their chronic back pain through five supportive approaches. The long term impact of the pain clinic could not be fully evaluated, and further research is needed to assess the effectiveness of pain management services of this kind.

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Sturycz, Cassandra A. "Subjective Vs. Objective Physical Pain in Individuals Who Report a History of Nonsuicidal Self-Injury: A Closer Look at What it Means to Experience Pain." TopSCHOLAR®, 2014. http://digitalcommons.wku.edu/theses/1404.

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Non-Suicidal Self-Injury (NSSI) is the self-inflicted damage to one’s bodily tissues without the intent to die. Previous research has sought to discover the motivation of an individual to perform such behavior and differences in the experience of pain among those who self-injure. The goals for the current study were to reveal any relationships between the function of NSSI, the subjective experience of pain, and an objective measurement of pressure pain threshold. Participants completed the Inventory of Statements About Self- Injury (ISAS; Klonsky & Glenn, 2009), which measures the functions that NSSI serves, and a measure assessing subjective pain experience, specifically frequency and severity of pain. Pain thresholds were also induced and recorded using a pressure algometer. The findings suggest that pain frequency significantly predicted pain threshold, whereas subjective pain severity did not. Furthermore, marking distress, the function of NSSI which serves as creating a tangible representation of emotional distress, was significantly associated with pain frequency, such that as marking distress increases in relevance, the less often one would be expected to experience pain. Therefore, the current study has implications relevant to both future research and the clinical setting.

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Eaves, Emery R., Karen J. Sherman, Cheryl Ritenbaugh, Clarissa Hsu, Mark Nichter, Judith A. Turner, and Daniel C. Cherkin. "A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies." BioMed Central Ltd, 2015. http://hdl.handle.net/10150/610275.

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BACKGROUND: The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants' expectations of treatment changed over the course of a therapy. METHODS: We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time. RESULTS: Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a "positive outcome". Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health. CONCLUSIONS: The shift in treatment expectations to greater acceptance of pain and the need for continued self-care suggests that future research should explore how CAM practitioners can capitalize on these shifts to encourage feelings of empowerment rather than disappointment surrounding realizations of the need for continued engagement with self-care.

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White, Rachel. "The splendour of the insignificant : an investigation of sacred and mundane landscapes and the alchemy of light." Thesis, University of Derby, 2017. http://hdl.handle.net/10545/621819.

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This study aims to contextualise my own photographic practice in relation to the interaction between mundane and sacred landscapes and the role that the transformative alchemy of light has on our perception of the ordinary. Reference will be made to the development of the genre of landscape photography, with particular reference to the selective aesthetic of pristine Wilderness, as embodied in the work of Ansel Adams, through the ‘man-altered’ landscapes of the New Topographics and Mark Klett’s rephotographic project, to discuss an aesthetic of the everyday. Reference will also be made to the benefits to health and wellbeing that can be achieved as a result of engaging in a state of mindfulness (Crane), also known as optimal experience or flow (Csikszentmihalyi) through photographic practice. Rather than narrowing the focus of the study by excluding relevant information to make the research less complex, the thesis comprises information from a diverse range of disciplines encompassing both the more obviously creative subjects of photography, aesthetics and poetry and areas such as health care. Given the parameters of the PhD process in relation to the breadth of the research undertaken, the specific study of each diverse element is, of necessity, not as detailed as it may have been had a single, more specifically defined, area of research been the entire focus of the research. The inclusive nature of the research presented in this thesis offers unique insights by providing direct comparisons and establishing new relationships between the theoretical and methodological approaches of a range of differing disciplines. While a written thesis forms part of the dissemination of the research findings the images that have emerged as a result of engagement with the study will be exhibited as an integral element of the outcome. The images that have been created as a result of the research process will take their place as objects within the world, offering viewers potential new ways of perceiving and experiencing what Rancière refers to as the ‘splendour of the insignificant’ within the landscape of their own everyday lives.

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Andersson, Lisa, and Melina Moberg. "Mer än enkla åtgärder : En litteraturöversikt om hur personer med långvarig smärta beskriver egenvård." Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-5014.

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Bakgrund: Smärta är en multidimensionell och subjektiv upplevelse som kan drabba alla människor. Smärta är den vanligaste orsaken till uppsökande av sjukvård samt orsakande av funktionsnedsättningar och oförmåga att arbeta. Personer med långvarig smärta måste självständigt utföra en stor del av sin behandling och omvårdnad i form av egenvård. Det ingår i sjuksköterskans uppdrag att uppmuntra och stödja patienter till att utföra egenvård, dock finns ingen entydig definition av begreppet egenvård. Syfte: Att redogöra för hur personer med långvarig smärtproblematik beskriver egenvård. Metod: En litteraturöversikt baserad på tio vetenskapliga artiklar med kvalitativa och kvantitativa ansatser. Artiklarna togs fram via sökningar i databaserna CINAHL Complete och MEDLINE, och var publicerade mellan åren 2005-2015. Artiklarna har analyserats enligt Fribergs analysmetod. Resultat: Resultatet i litteraturöversikten presenterade att personer med långvarig smärta beskrev egenvård som multidimensionell. Egenvård ansågs bestå av personliga förmågor samt mentala och praktiska strategier. Personer med långvarig smärta ansåg även att utbildning och stöd ifrån hälso- och sjukvården var viktigt för utförandet av egenvård. Diskussion: Resultatet har diskuterats utifrån Dorothea Orems omvårdnadsteori om egenvårdsbalans samt vetenskapliga publiceringar. Egenvårdens innebörd för personer med långvarig smärta har jämförts med de olika definitioner av egenvård som tillämpas inom hälso- och sjukvården. Vidare har egenvårdsdefinitionernas betydelse för hälso- och sjukvårdens egenvårdsstödjande insatser diskuterats.
Background: Pain is a multidimensional and subjective experience that can affect anyone. Pain is the most common reason to seek medical care and is the main cause to disability and inability to work. People with chronic pain need to independently manage a large part of their treatment and care in the form of self-management. One part of the nursing role is to encourage and support patients to perform self-management, however there is no clear definition of the term self-management. Aim: To illustrate how people with chronic pain describes self-management. Method: The literature review was based on ten scientific articles, with qualitative and quantitative approaches. The articles were found through searches in the databases CINAHL Complete and MEDLINE, with publication between the years 2005-2015. The articles were analyzed using Fribergs method of analysis. Results: The literature review showed that people with chronic pain described that self-management was multidimensional. Self-management was considered to involve both personal abilities, mental and practical strategies. People with chronic pain also believed that education and support from healthcare was essential for self-management. Discussion: The result has been discussed against Dorothea Orems nursing theory about self-care and relevant scientific publications. The meaning of self-management for people with chronic pain has been compared with various definitions of self-management that are applied in healthcare. Furthermore the definitions of self-management were put in relation to how the healthcare provide supporting self-management interventions.

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Igwesi-Chidobe, Chinonso Nwamaka. "Development and preliminary evaluation of a self-management programme for people with non-specific chronic low back pain in rural Nigeria." Thesis, King's College London (University of London), 2017. https://kclpure.kcl.ac.uk/portal/en/theses/development-and-preliminary-evaluation-of-a-selfmanagement-programme-for-people-with-nonspecific-chronic-low-back-pain-in-rural-nigeria(301292be-3085-4be7-9da1-5f14c1bd055d).html.

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Background: There is currently no access to effective treatment of low back pain (LBP) in rural Nigeria despite its significant burden in this context. This increases disability, deepens poverty, and reinforces rural-urban inequality. Evidence from developed countries suggests that psychosocial factors are associated with chronic low back pain (CLBP) disability, but no research has examined these factors in rural Nigeria. This PhD aims to explore the biopsychosocial factors associated with CLBP disability in rural Nigeria, and then develop and test the feasibility of an intervention to address them. Methods: Six studies were conducted as part of this PhD. Two qualitative studies to explore the experiences of people living with CLBP (Study 1), and the management of CLBP (Study 2) in rural Nigeria. The cross-cultural adaptation and psychometric testing of measures to assess any suggested biopsychosocial factors (Study 3). A cross-sectional survey to investigate the biopsychosocial factors associated with CLBP disability in rural Nigeria (Study 4). A systematic review to assess the intervention components to improve acceptability of exercises and physical activity behaviour in people with chronic non-communicable diseases in Africa (Study 5). The development of an exercise-based self-management programme (SMP) to target biopsychosocial factors associated with CLBP disability in rural Nigeria, and then conduct a feasibility study of this programme (Study 6). Results: Study 1 found maladaptive beliefs and coping strategies, emotional distress and disability among individuals with CLBP. Study 2 showed that CLBP was predominantly managed within a biomedical model. Study 3 found that the adapted measures were reliable and valid for use in rural Nigeria. Study 4 showed that psychosocial factors explained 63% and 49% of the variance in self-reported and performance-based CLBP disability respectively. Study 5 suggested that behavioural rehearsal/practice, habit formation, and restructuring the physical and social environment improved the acceptability of exercises, and physical activity behaviour. Study 6 found that the SMP was feasible and acceptable to participants, and had potential in terms of clinical (biopsychosocial) outcomes. Conclusions: This PhD has enabled the identification of the biopsychosocial factors associated with CLBP disability in rural Nigeria, and the development of a novel intervention that shows promise in addressing them.

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Harrison, Anthony Mark. "Development of a theoretical model and preliminary evaluation of a self-management programme for different types of pain in Multiple Sclerosis." Thesis, King's College London (University of London), 2016. http://kclpure.kcl.ac.uk/portal/en/theses/development-of-a-theoretical-model-and-preliminary-evaluation-of-a-selfmanagement-programme-for-different(85759b2d-27f6-4c23-b7a6-1894caaa4022).html.

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Previous research indicates that many people with MS (pwMS) experience pain. Studies show that pain is associated with several potentially unhelpful psychosocial factors or processes, which may impact on pwMS’ functioning and quality of life. This thesis presents a series of studies outlining the development of a theoretical model of Multiple Sclerosis (MS) pain and a preliminary intervention to support pain management for pwMS. Study 1: A systematic review of the literature proposed a cognitive behavioural model of MS pain showing that several psychosocial factors are associated with pain and related disability. A literature review of predominant theoretical models in chronic pain, their key constructs, empirical evidence, and treatment approaches, were shown to have comparable efficacy, and may potentially be relevant to pwMS. Study 2: Following the literature reviews, a qualitative interview study exploring pwMS experiences of pain (n = 25) provided insights into pain-related beliefs, emotional reactions, disparate pain management attitudes and behaviours. Study 3: A large quantitative cross-sectional questionnaire study of pwMS (n = 608) explored additional psychological factors, focusing on theory and gaps identified within the literature reviews. Cognitive and contextual behavioural variables explained substantial variance in pain and related functioning. Study 4: The literature reviews, interviews and survey refined the MS pain model. This informed the development of a telephone supported hybrid cognitive and contextual behavioural self-management intervention aiming to alleviate the negative impact of pain in MS. Study 5: A case series (n = 7) explored the potential efficacy of the self-management intervention for pwMS with different types of MS pain, showing mixed findings in pain outcomes and psychological process variables from the MS pain model. This project has improved our understanding of MS pain, providing a potential tool that requires further evaluation, which may help pwMS better manage pain more effectively in the future.

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Alreshidi, Nahar Mohammad. "The impact of an interactive educational programme on children's nurses' knowledge, attitudes, beliefs and perceptions of children's pain, self-efficacy, and perceptions of barriers to optimal post-operative pain management in children." Thesis, University of Salford, 2016. http://usir.salford.ac.uk/40987/.

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Background Although post-operative pain management has been researched extensively, it does not receive the same attention from paediatric nurses in Saudi Arabia. Practices are not based on sound evidence, but there is a willingness to improve. The factors addressed in this study had not been considered together in any study, and each in turn was supported by only minimal evidence of variable quality. No work of significance had been undertaken in the context of Saudi Arabia or other Gulf nations. Aims The aim was to test the impact of an interactive online post-operative pain management education programme on paediatric nurses’ knowledge, attitudes, beliefs and perceptions of children’s pain; self-efficacy; and perceptions of barriers to optimal practice. Study Design A non-equivalent groups pre-test post-test design was used. A sample of 229 paediatric nurses working in surgical wards in Hail region hospitals was recruited (intervention n=135; control n=94) and completed four instruments to test the study variables on three occasions: before the intervention, and at one and three months afterwards. The intervention was an interactive educational programme on DVD with explanations, exercises, video presentations and self-check games. Analysis of categorical variables was undertaken using descriptive statistics, and ANOVA inferential statistics were used to compare the results within and between groups. Results In the intervention group statistically significant, positive changes were seen in all attributes other than nurses’ perceptions of children’s pain. Such changes were not observed in the control group. Participants were explicit in approval of the intervention. Conclusion The online education programme was effective in equipping Saudi nurses with the skills, knowledge and self-confidence to undertake effective post-operative pain management. Shift patterns, geographical distances and cultural issues in Saudi hospitals make attendance at educational events difficult, so this approach could exert a notable impact on clinical practice throughout Saudi Arabia.

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Granat, Nicklas, and Sofie Malmström. "Internetbaserade interventioners effekter vid långvarig smärta : En begränsad systematisk litteraturöversikt." Thesis, Röda Korsets Högskola, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-2827.

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Bakgrund: Långvarig smärta är en av de främsta orsakerna till varaktigt lidande och funktionsnedsättning både i Sverige och globalt. Dagens behandlingsmetoder anses i många fall bristfälliga. I ett allt mer högteknologiskt samhälle utvecklas elektroniska hjälpmedel som stöd till personer med olika sjukdomstillstånd. Tidigare studier visar att internetbaserade interventioner främjar hälsa, lindrar lidande och ökar egenmakten, dock är området fortfarande under snabb utvecklig. Syfte: Att beskriva effekterna av internetbaserade interventioner riktade mot långvarig smärta. Metod: Begränsad systematisk litteraturöversikt med elva kvantitativa artiklar. Resultat: Fem av artiklarna använde KBT, tre artiklar använde ACT och tre artiklar använde självhanteringsmetoder. Fyra effekter av interventionerna framkom; smärtreducering, smärthantering, livskvalitet och psykisk hälsa. Smärthantering förbättrades signifikant, resterande förbättrades, dock ej signifikant. Effekterna är förbättrade till signifikant förbättrade vid uppföljningar efter avslutad behandling. Slutsats: Att införa internetbaserade interventioner som tillägg till klinisk omvårdnad kan innebära hälsovinster för enskild person samt för samhället. Dock ses svårigheter att implementera den här typen av intervention på en större befolkning då faktorer som tillgänglighet och könsfördelning påverkar negativt. Fortsatt forskning: Jämnare könsfördelning i studier, större geografisk utbredning samt långtidsuppföljningar bör ligga i fokus för framtida forskning.
Background: Chronic pain is one of the primary causes to abiding suffering and disabilities in Sweden and globally. Today’s treatment methods are somewhat considered lacking. In a high technology society, as the one we are living in today, the developing of electronic aids for persons with different disease states increases. Internet-based interventions is considered a part of the future in health care. Aim: The aim of this study was to describe the effects of Internet-based interventions designed for people with chronic pain. Method: A rapid systematic review with eleven quantitative studies. Result: Five studies used CBT, three studies used ACT and three is denominated as self-management. Four effects became clear; mental health, pain management, pain reducing, and quality of life. Pain management showed significant improvement, the other three effects showed improvement, although no significant improvement. At follow-up after post intervention the effects improved, some with significance. Conclusion: To implement internet-based interventions as an addition to clinical care could mean health benefits for the community as well as the individual person. However, this intervention type is not accessible on a larger population. Further Research: There should be focus on gender equality, broader geographic areas and longer follow-ups in future research.

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Lisselmo, Olivia, and Therése Uppling. "Att leva med långvarig smärta : en litteraturöversikt av patienters upplevelse." Thesis, Mittuniversitetet, Institutionen för omvårdnad, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-38264.

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Bakgrund: Långvarig smärta är ett stort problem världen över. Egenvård är en viktig faktor för hanteringen av smärta för att uppnå livskvalitet. Syfte: Syftet var att undersöka patienters upplevelse av att leva med och hantera den långvariga smärtan i det dagliga livet. Metod: En allmän litteraturöversikt baserad på 15 kvalitativa artiklar, analyserade med en innehållsanalys med en manifest ansats. Resultat: Acceptans upplevdes vara det första steget mot hanteringen av smärta. Att leva med långvarig smärta upplevdes påverka både fysiska och psykiska aspekter. Genom att utöva egenvård upplevdes hanteringen av den långvariga smärtan underlätta. Patienterna upplevde ett behov av stöd från familj, vänner och hälso-och sjukvård. Diskussion: Upplevelsen av att leva med långvarig smärta i det dagliga livet varierade och det fanns både positiva och negativa erfarenheter. Slutsats: Hanteringen av smärta visade sig vara en pågående process. Om sjuksköterskan har kunskap och kompetens om hur patienterna upplever sitt långvariga tillstånd så kan det vara lättare att förstå och vägleda dessa patienter. Det ger en kunskap om hur patienterna kan uppleva smärt situationen och hanteringen av smärtan.
Background: Chronic pain is a major problem worldwide. Self-care is an important factor when it comes to managing pain to achieve quality of life. Aim: The purpose was to investigate patients' experience of living with and manage the chronic pain of daily life. Method: A general literature review based on 15 qualitative articles, analyzed with a qualitative content analysis with a manifest approach. Result: Acceptance was perceived to be the first step towards the management of pain. Living with long-term pain was felt to affect both physical and mental aspects. By practicing self-care, the management of the chronic pain was made easier. Patients experienced a need for support from family, friends and healthcare. Discussion: The experience of living with chronic pain in daily life varied and there were both positive and negative experiences. Conclusion: The management of pain proved to be an ongoing process. If the nurse has knowledge and skills about how patients experience their chronic condition, it may be easier to understand and guide these patients. It provides a knowledge of how patients can experience the pain situation and the management of pain.

Examinationsdatum: 2019-12-04

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Hasson, Dan. "Stress Management Interventions and Predictors of Long-term Health : Prospectively Controlled Studies on Long-term Pain Patients and a Healthy Sample from IT- and Media Companies." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5944.

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Russell, Matthew E. B. "THE ROLE OF DIAPHRAGMATIC BREATHING IN SELF-REGULATION SKILLS TRAINING." UKnowledge, 2018. https://uknowledge.uky.edu/psychology_etds/130.

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A central component of many psychological interventions is breathing training. Breathing training protocols based on a mindfulness or a cognitive behavioral therapy (CBT) have demonstrated value in the management of psychological and medical ailments. Yet, despite the wealth of literature examining each approach, little direct comparison exists. An additional concern is the proliferation of smart phone health (mHealth) applications (apps) providing breathing training with little empirical evidence to support their clinical use. A possible explanation for the interest in breathing and mHealth apps is the growing body of literature indicating breathing training provides wide ranging health benefits through improved stasis of the autonomic nervous system (ANS). As ANS dysregulation underlies many chronic health conditions such as persistent temporomandibular disorders (TMDs), there is a need for empirical research to identify the most effective modality of breathing training and validate the clinical efficacy of breathing based mHealth apps. Study One compared the effectiveness of a mindfulness breathing meditation (MB) and a CBT based protocol teaching diaphragmatic breathing (DB) to improve biomarkers of ANS stasis. An attention control approach based on the Nolen-Hoeksema task (C) was included as a comparison group. Ninety participants were randomly assigned to either the MB, DB, or C condition. Within each condition, 30 participants were provided skills training with practice time and completed a behavioral self-regulation task. Participants in the DB condition approach had significantly lower breathing rates than those in the MB and C conditions (p < .001). DB condition participants experienced improvements on high-frequency heart rate variability (p < .05) and the standard deviation in NN intervals (p < .001), which served as indicators for ANS stasis. No differences were found between conditions on the behavioral self-regulation task (p’s > .05). Given these results, the DB training protocol was converted into a mHealth app to facilitate a clinical trial with patients suffering persistent TMDs. Study Two examined the additive benefits of including the mHealth app with standard dental care (SDC+) versus standard dental care alone (SDC). Nineteen patients seeking care for persistent TMDs were recruited. All participants were asked to track daily ratings of pain (VAS), relaxation (RR), and complete weekly assessments on several comorbid psycho-social factors. Within the SDC+ condition participants were asked to track the proximate effects of each breathing practice on VAS and RR ratings. Given a high drop-out rate (nine participants) and low overall sample size (N = 10), results are exploratory at best. Within the SDC+ condition, results indicated reliable improvements in average VAS and RR ratings from before and after SDC+ participants used the mHealth app (p’s < .05). Within a one session training paradigm, results supported the use of a DB based intervention above the use of a MB or C intervention. Future research should consider the effects of having multiple training sessions. Study Two results were complicated by a limited sample size and failed to provide a clear picture of whether the conjunctive treatment in the SDC+ condition provided additional symptom relief above traditional dental care alone. Although exploratory results indicated the mHealth app provided temporary improvements in pain and feelings of relaxation, a well powered trial is needed to clarify whether the finding represents an enduring treatment effect.

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Clarke, Rochelle S. "Uncovering Meanings of Death, Trauma, and Loss as Experienced by Hospice Bereavement Coordinators: A Phenomenological Study." NSUWorks, 2015. http://nsuworks.nova.edu/shss_dft_etd/12.

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This study examined the experiences of Hospice Bereavement Coordinators (HBCs) and Hospice Chaplains working with grief narratives from patient-family units exhibiting signs of anticipatory or complicated grief. While a significant amount of research has been conducted on Hospice employees, no qualitative studies have examined the interpretation of meaning from employees whose primary role focused on the psychosocial-spiritual aspects of clients exhibiting anticipatory or complicated grief. The researcher identified shared meaning of death, trauma, and loss from six participants in the context of a high stress and high loss environment. This study‘s findings revealed ten central themes: Death is an earthly transition to immortality; Death is an intense progression; Trauma is an interpretive response to a bad experience; Trauma highlights quality of life; Loss is an adaptation to change; Loss highlights self-awareness about mortality; Cases impact views of death, trauma, and loss; Influences of spirituality; Stressful aspects of working in hospice settings; and Methods of coping. Through this study, the researcher captured five elements of the shared phenomena: the conflicting nature of anticipatory or complicated grief with the participant‘s interpretation of death; the acknowledgement of loss as the next stage for survivors of the deceased; the instability patient-family units exhibiting anticipatory or complicated grief faced; the role of faith; and the proactive efforts of participants to create a balance between work and their personal life. These meanings contributed to the continued need for future qualitative studies whereby the lived experiences of Hospice employees could be expressed to assist with the development of structured training programs specific to the requirements outlined by the nature of their work.

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Krok, Jessica. "The Relationship between Self-Reported Cancer Pain and Personality in Black and White Older Adults receiving Outpatient Cancer Care." Scholar Commons, 2012. http://scholarcommons.usf.edu/etd/4109.

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It is well-established that personality not only affects physical health and longevity, but also mental health and coping mechanisms. One area of limited research is the relationship between cancer pain and personality. This study examined how personality traits affect reported cancer pain severity in older patients (N = 150) receiving outpatient treatment at a comprehensive cancer center. Participants were interviewed regarding their pain severity, personality, affect, and self-efficacy for pain management. Symptom data were collected from the Brief Pain Inventory, while personality data were gathered from the Ten Item Personality Inventory and the Positive and Negative Affect Schedule. Self-efficacy for pain management was collected from the Chronic Pain Self-efficacy Scale. Analyses included descriptives, Chi-square tests, t-tests, stepwise linear regressions, and moderation analyses. The mean age of the sample was 65.38 ± 7.72 years. Seventy-nine percent of the sample was White. Analyses indicated that the average pain was 4.15 ± 2.01 (0-10 scale; with 10 being worst pain), with the sample recording means of 6.53 ± 2.57 and 2.45 ± 2.15 on worst and least pain, respectively. Regression analyses showed extraversion (â = -0.21, p < .01) and openness to experience (â = 0.18, p < .05) to be significant predictors of higher current and average pain severity, respectively. Agreeableness (â = 0.18, p < .05) was found to be a significant predictor of higher self-efficacy for pain management. Conscientiousness and extraversion were significant moderators in the relationship between self-efficacy for pain management and worst pain severity. These findings indicate that different personality types and personal affect may influence reports of pain severity. More empirical research is needed to understand the impact of personality and its relationship with pain severity and self-efficacy for pain management in more diverse and marginalized cancer populations across the age continuum. Finally, the results may be used to design more individualized interventions on pain management, depending on personality type, an application that has never been done in older adults with cancer.

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Govender, Yolin. "Is conventional sugar-free chewing gum effective in the management of orthodontic pain associated with fixed appliances? A randomised clinical trial comparing the pain-reducing effects of sugar-free chewing gum versus a placebo medicament." University of the Western Cape, 2020. http://hdl.handle.net/11394/7536.

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Magister Scientiae Dentium - MSc(Dent)
Background and aim: Managing orthodontic pain traditionally involves the prescription of non-steroidal anti-inflammatory drugs combined with other analgesic medication. Sugar-free chewing gum has been advocated in the control of orthodontic pain due to its mechanical and physiological effects on periodontal tissue; however, the literature is scant. The ‘placebo effect’ that conventional sugar-free chewing gum may have in the relief of orthodontic pain has not been documented. The aim of this study was to compare the effectiveness of conventional sugar-free chewing gum in reducing orthodontic pain associated with fixed appliances with a placebo (sugar-free sweets) medicament. Objectives: The objectives of the study were to determine if there were differences in pain reporting between the sugar-free chewing gum and the placebo, to ascertain whether gender influenced pain scores and to observe any differences in pain reporting between different orthodontic techniques.

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Hosterno, Patricia Marques Freire. "A gestão dos recursos financeiros pelas APMCs das escolas da Coordenadoria Distrital 03 de Manaus." Universidade Federal de Juiz de Fora (UFJF), 2018. https://repositorio.ufjf.br/jspui/handle/ufjf/6701.

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A presente dissertação foi desenvolvida no âmbito do Mestrado Profissional em Gestão e Avaliação da Educação (PPGP) do Centro de Políticas Públicas e Avaliação da Educação da Universidade Federal de Juiz de Fora (CAEd/UFJF). O caso de gestão estudado discute as dificuldades na gestão dos recursos financeiros recebidos pelas Associações de Pais, Mestres e Comunitários (APMCs) das escolas da Coordenadoria Distrital de Educação 03 (CDE 03) da Secretaria de Estado e Qualidade de Ensino (Seduc-AM), localizadas na zona centro-oeste e centro-sul de Manaus. Como objetivo geral para este estudo, intencionou-se identificar as principais dificuldades das APMCs para realizar a gestão dos recursos financeiros, considerando-se a necessidade do cumprimento das leis e normas estabelecidas para aplicação dos recursos destinados às escolas públicas, e propor, a partir dos resultados da pesquisa, um Plano de Ação Educacional (PAE) voltado para a melhoria do planejamento, execução e prestação de contas dos recursos financeiros, bem como para o fortalecimento da autogestão escolar. Nesse sentido, definimos como questão norteadora para o caso: quais os entraves à gestão dos recursos financeiros realizada pelas APMCs da CDE 03? Diante de tal contexto, assumimos como hipótese que os membros das APMCs desconhecem as legislações dos programas federais e estaduais e os critérios de repasse dos recursos vinculados a eles, bem como as obrigações legais, ou seja, as atribuições enquanto entidade de direito privado que declara tributos e, ainda, que os membros da Diretoria da APMC, em especial presidente e tesoureiro, não possuem um tempo específico dentro de sua carga horária de trabalho na escola destinado para realizar as ações que competem a tais funções. Como conceitos teóricos principais discutidos, debatemos a descentralização das políticas e recursos educacionais, a partir de Oliveira (2014); o planejamento participativo, com base em Gandin (2001) e Ganzeli (2001); o autogoverno e a autonomia, por meio das discussões de Parente e Lück (1999) e Barroso (2004); o planejamento e a gestão, amparados em David et al (2012); a gestão de recursos, balizados em Mendes e Nunes (2007); a administração escolar, a partir de Paro (2010) e a prestação de contas, com base em Costa, Silva e Nova (2014), entre outros. Para a pesquisa de campo, utilizamos as entrevistas semiestruturadas, destinadas aos presidentes das APMCs e aos diretores de quatro escolas da CDE 03. As principais conclusões da análise confirmaram as hipóteses iniciais, apontando para: o desconhecimento por parte dos sujeitos das competências, legislação, dos aspectos contábeis, bem como a ausência de articulação da aplicação de recursos e proposta educacional da escola; a dificuldade na organização e apresentação da documentação exigida para a prestação de contas. Assim, o PAE está formulado com base em três proposições: formação continuada e em contexto em gestão financeira, encontro de APMCs e Conselhos Escolares para a gestão financeira na escola e criação de um espaço on-line para interação APMCs/CDE 03.
The present dissertation was conducted within the scope of the Professional Master's Degree in Management and Educational Evaluation (PPGP) of the Public Policies and Educational Evaluation Center at the Universidade Federal de Juiz de Fora (CAEd/UFJF). The case of management studied discusses the difficulties in managing financial resources received by the Parents, Teachers and Community Associations (APMCs) of the schools at the District Office of Education 03 (CDE 03) in the Secretary of State and Quality of Education (Seduc–AM), located at the Central-west and South Central part of Manaus. As the main aim, it was intended to identify the main difficulties of the APMCs to manage financial resources, considering the need to comply with laws and established rules for the application of resources in public schools; and propose, from the results of the research, an Educational Action Plan (PAE) aimed at improving the planning, execution and accountability of financial resources, as well as strengthening school self-management. In this sense, we define as the leading question for the case: what are the obstacles to the management of financial resources carried out by the APMCs of CDE 03? Given the context of the study, we assume as a hypothesis that the members of the APMCs are unaware of the federal and state legislation and the criteria for transferring resources related to them, as well as the legal obligations, that is, the attributions as a private law entity that the members of the APMC board of directors, especially the president and treasurer, do not have a specific time within their working hours in the school to carry out the actions that are not due to such functions. As main theoretical concepts approached, we discussed the decentralization of educational policies and resources from Oliveira (2014), the participatory planning based on Gandin (2001) and Ganzeli (2001), self-government and autonomy by means of discussions by Parente and Luck ( 1999) and Barroso (2004), planning and management by David et al. (2012), resource management by Mendes and Nunes (2007), school management by Paro (2010) and accountability by Costa, Silva and Nova (2014), among others. For the field research, we used the semi-structured interviews with the APMCs presidents and the principals of four schools at the CDE 03. The main conclusions of the analysis confirmed the initial hypotheses, pointing to the lack of knowledge by the subjects of the competences, legislation, accounting aspects, as well as the absence of articulation of the application of resources and school educational proposal; difficulty in organizing and presenting the documentation required to the accountability. The PAE is formulated on the basis of three propositions: continuous and in-service training in financial management, APMCs meeting and School Councils for financial management in the school and creation of an online space for APMCs/CDE 03 interaction.

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Hart, M. J. Alexandra. "Action in Chronic Fatigue Syndrome: an Enactive Psycho-phenomenological and Semiotic Analysis of Thirty New Zealand Women's Experiences of Suffering and Recovery." Thesis, University of Canterbury. Social and Political Sciences, 2010. http://hdl.handle.net/10092/5294.

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This research into Chronic Fatigue Syndrome (CFS) presents the results of 60 first-person psycho-phenomenological interviews with 30 New Zealand women. The participants were recruited from the Canterbury and Wellington regions, 10 had recovered. Taking a non-dual, non-reductive embodied approach, the phenomenological data was analysed semiotically, using a graph-theoretical cluster analysis to elucidate the large number of resulting categories, and interpreted through the enactive approach to cognitive science. The initial result of the analysis is a comprehensive exploration of the experience of CFS which develops subject-specific categories of experience and explores the relation of the illness to universal categories of experience, including self, ‘energy’, action, and being-able-to-do. Transformations of the self surrounding being-able-to-do and not-being-able-to-do were shown to elucidate the illness process. It is proposed that the concept ‘energy’ in the participants’ discourse is equivalent to the Mahayana Buddhist concept of ‘contact’. This characterises CFS as a breakdown of contact. Narrative content from the recovered interviewees reflects a reestablishment of contact. The hypothesis that CFS is a disorder of action is investigated in detail. A general model for the phenomenology and functional architecture of action is proposed. This model is a recursive loop involving felt meaning, contact, action, and perception and appears to be phenomenologically supported. It is proposed that the CFS illness process is a dynamical decompensation of the subject’s action loop caused by a breakdown in the process of contact. On this basis, a new interpretation of neurological findings in relation to CFS becomes possible. A neurological phenomenon that correlates with the illness and involves a brain region that has a similar structure to the action model’s recursive loop is identified in previous research results and compared with the action model and the results of this research. This correspondence may identify the brain regions involved in the illness process, which may provide an objective diagnostic test for the condition and approaches to treatment. The implications of this model for cognitive science and CFS should be investigated through neurophenomenological research since the model stands to shed considerable light on the nature of consciousness, contact and agency. Phenomenologically based treatments are proposed, along with suggestions for future research on CFS. The research may clarify the diagnostic criteria for CFS and guide management and treatment programmes, particularly multidimensional and interdisciplinary approaches. Category theory is proposed as a foundation for a mathematisation of phenomenology.

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El, Jadie Amna. "L'énergie nucléaire et le droit international public." Thesis, Tours, 2017. http://www.theses.fr/2017TOUR1006/document.

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Tous les États sans discrimination ont un droit inaliénable de développer les utilisations de l'énergie nucléaire à des fins civiles, à condition de ne pas détourner ces utilisations pacifiques vers des armes nucléaires. Cependant, il est accordé à cinq pays le droit de posséder ces armes, à savoir les États-Unis, la France, la Russie, la Chine et le Royaume-Uni. Autour de cette position, un vif débat à la fois juridique et éthique a été soulevé. En effet, pour ses opposants, le nucléaire représente un risque durable et non maîtrisable par la science. Les accidents nucléaires majeurs, les déchets radioactifs et le détournement du nucléaire à des fins militaires sont des risques ingérables et d‟une gravité exceptionnelle. En revanche, les défenseurs de cette énergie la présentent comme sûre, voire partie prenante du développement durable. Selon eux, le nucléaire est un moyen fiable de lutter contre le réchauffement climatique et aussi une solution à la pénurie énergétique à laquelle le monde est confronté. En examinant et analysant la fiabilité et la crédibilité de tous les arguments allant à l‟encontre et en faveur de cette industrie, on constate que la licéité et la légitimité du recours à l'énergie nucléaire sont mal fondées. Par conséquent, nous estimons qu‟il est nécessaire de dépasser le nucléaire par la conclusion d'une convention internationale posant l'interdiction progressive mais complète du nucléaire
All states without discrimination have an inalienable right to develop the uses of nuclear energy for civilian purposes, provided they do not divert these peaceful uses to nuclear weapons. However, five states have been granted the right to possess these weapons, that is : United-States, France, Russia, China and United-Kingdom. Around this position a fierce debate, both legal and ethical, has been raised. Indeed for its opponents nuclear represents a persistent risk that is non controllable by science. Major nuclear accidents, radioactive wastes and the use of nuclear for military purposes are unmanageable risks of exceptionnal serious gravity. On the other hand, the proponents of this energy present it as safe, even as part of sustainable development. According to them, nuclear is a reliable means to fight global warming and is also a solution to the energy shortage the world is facing. When analyzing the reliability and the credibility of all arguments for and against this industry, it can be noticed that the lawfulness and legitimacy of the use of nuclear energy are ill-founded. Therefore, we believe there is a need to go beyond nuclear with the conclusion of an international convention dealing with the progressive but comprehensive nuclear ban

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Mann, Elizabeth Gayle. "Self-Management of Chronic Pain: Interventions, Strategies, Barriers, and Facilitators." Thesis, 2013. http://hdl.handle.net/1974/8321.

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Background & Purpose: Chronic pain is a prevalent chronic condition for which the best management options rarely provide complete relief. Individuals with chronic pain with neuropathic characteristics (NC) report more severe pain and experience less relief from interventions. Little is known about current self-management practices. The purpose of this dissertation was to inform self-management of chronic pain with and without NC at the individual, health system, and policy levels using the Innovative Care for Chronic Conditions Framework. Methods: The study included a systematic search and review and cross-sectional survey. The review evaluated the evidence for chronic pain self-management interventions and explored the role of health care providers in supporting self-management. The survey was mailed to 8,000 randomly selected Canadians in November 2011, and non-respondents were followed-up in May 2012. Screening questions were included for both chronic pain and NC. The questionnaire captured pain descriptions, self-management strategies, and self-management barriers, and facilitators. Results: Findings of the review suggested that self-management interventions are effective in improving pain and health outcomes. Health care professionals provided self-management advice and referred individuals to self-management interventions. The questionnaire was completed by 1,520 Canadians. Those with chronic pain (n=710) identified primary care physicians as the most helpful pain management professional. Overall, use of non-pharmaceutical medical self-management strategies was low. While use positive emotional self-management strategies was high, individuals with NC were more likely to use negative emotional self-management strategies compared to those without NC. Multiple self-management barriers and facilitators were identified, however those with NC were more likely than those without NC to experience low self-efficacy, depression and severe pain which may impair the ability to self-management. Conclusions: Health care professionals have the opportunity to improve chronic pain outcomes by providing self-management advice, referring to self-management interventions, and addressing self-management barriers and facilitators. Individuals with NC may require additional health services to address their greater self-management challenges, and further research is needed to identify non-pharmaceutical interventions effective in relieving chronic pain with NC. Public policy is needed to facilitate health systems in providing long-term self-management support for individuals with chronic pain.
Thesis (Ph.D, Nursing) -- Queen's University, 2013-09-25 12:57:58.59

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"Maintenance of chronic pain self-management behaviors after completion of a multidisciplinary pain treatment program." ILLINOIS INSTITUTE OF TECHNOLOGY, 2010. http://pqdtopen.proquest.com/#viewpdf?dispub=3370895.

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Mikan, Sabrina Quintanilla. "Pain management experiences in adults living with HIV/AIDS." Thesis, 2011. http://hdl.handle.net/2152/ETD-UT-2011-08-3864.

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Even though pain is common and often chronic in people living with HIV/AIDS (PLWHA), the management of pain is complicated and frequently woefully inadequate. Many factors influence the way PLWHA experience and communicate their pain. These factors can be categorized as both physiological and emotional. PLWHA often resort to self-care activities to control their pain because of the pervasive lack of adequate pain management by health care providers. The purposes of this study were to increase understanding of the pain management experiences in people living with HIV/AIDS (PLWHA) who report chronic pain and to elucidate the factors that influence this experience. Recruitment was conducted at 3 locations in Central Texas, USA; serving over 3,000 clients/year. A cross-sectional descriptive design and open-ended questions were used to explore PLWHA experiences in reporting chronic pain needs for at least 3 months and to describe pain management choices (self-care and/or seeking care activities) and communication with health care providers. Variables of interest were assessed with paper-pencil surveys (HIV-Self Efficacy Questionnaire, Coping Inventory for Pain in Persons Living with HIV/AIDS and Pain Self-Efficacy Questionnaire) and open-ended questions. Interviews ranged from 7-35 minutes each. One hundred PLWHA participated in the study, 53% African-American, 21% Hispanic and 25% Caucasian. They were primarily male (66%), 34% female, reported a mean age of 48 years and a mean of 13 years living with HIV. 83% of the participants rated their pain as consistently moderate to high levels; 82% rated they are likely to “tolerate the pain.” A majority of the participants (63%) reported they exercise or walk as a way of self-managing their pain. There was a significant association between use of pain management choices (self-care and/or seeking care activities) and confidence in performing life activities (r= 0.344, p<0.05). These findings indicate a need for health care providers to move beyond quantitative measures for this complex problem. Clinicians can use this information to understand the coping strategies used by PLWHA to manage pain. Future implications will be to develop appropriate pain management approaches (behavioral and pharmacological) for health care providers to improve control of chronic pain in PLWHA. Longitudinal studies are needed to explore the causative relationships between pain management choices (self-care and/or seeking care activities) and functional outcomes in PLWHA.
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Stein, Matthew. "Program evaluation of the chronic pain self-management workshop in the workplace." Thesis, 2012. http://hdl.handle.net/10155/261.

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Chronic pain conditions can be extremely challenging to deal with in the workplace. The implications of these conditions extend far beyond the employees themselves and can create significant organizational impacts. The Chronic Pain Self-Management Program was developed by Dr. Sandra LeFort, and was originally based on the generic Stanford model of self-management. The six-week program, delivered weekly, is designed to explore and instruct those with chronic pain on different aspects of their condition. This pilot study used a mixed method design to evaluate the effectiveness of Chronic Pain Self-Management Program in the workplace. The quantitative measures for this study were unable to demonstrate the effectiveness of the workshop due to a lack of statistical significance. Through the qualitative measures it was possible to delve into how the chronic pain condition manifests itself in the workplace and what support systems are available for those with chronic pain. There are definitely some positive implications from this pilot research, but through further research it is possible to truly understand how people live with chronic pain in the workplace and how their conditions can be made more manageable.
UOIT

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Perry, JENNIFER. "GUIDED INTERNET-BASED COGNITIVE BEHAVIOURAL SELF-MANAGEMENT INTERVENTION FOR INDIVIDUALS WITH CHRONIC PAIN: A FEASIBILITY STUDY." Thesis, 2014. http://hdl.handle.net/1974/8607.

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Background: The “gold standard” in chronic pain treatment is multidisciplinary care. With long wait times to receive appropriate care, there is a need for improved access to non-pharmacological treatments in the time gap between primary and specialist care. The Internet is emerging as a tool for delivery of healthcare information and intervention. Using this format to offer access to chronic pain therapies prior to specialist intervention may improve outcomes. Objective: To develop and test a guided Internet-based intervention for individuals with chronic pain waiting for specialty care. Method: A novel, Internet-based chronic pain intervention (ICPI) was developed, using evidence-based concepts proven effective in face-to-face interventions. This study was designed to assess feasibility of conducting larger-scale research and usability of the ICPI, and to collect preliminary data on effectiveness of the intervention. Data were collected at baseline, after each of the six intervention modules and 12 weeks after completion of the intervention. Results: Participants with chronic pain (n=41) reported satisfaction with the structure of the intervention, and ease of use at and away from their computers. Use of the Internet as a recruitment strategy aided in accrual of participants, making further large-scale study of the ICPI feasible. Preliminary data showed that the ICPI was effective in improving emotional function, had no demonstrable effect on physical function and produced a small but significant decrease in average and current pain intensity and pain interference. Most participants felt they benefited at least minimally overall as a result of using the ICPI. Conclusion: The newly-developed ICPI was well-received by participants and demonstrated some positive outcomes in this preliminary study. Further research with more participants is feasible and necessary, to fully assess the effect of this intervention.
Thesis (Ph.D, Nursing) -- Queen's University, 2014-01-31 11:54:25.7

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McGowan, Patrick Thomas. "The relationship of self-efficacy with depression, pain, and health status in the arthritis self-management program." Thesis, 1996. http://hdl.handle.net/2429/6112.

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Over the past decade results from a series of research studies have contributed to the development and evaluation of the Arthritis Self-Management Program (ASMP), a volunteer-led patient education program for persons with arthritis. To date, these studies have primarily focussed on program effectiveness, process, implementation, and dissemination. In these studies self-efficacy was identified as an important construct contributing to the program's effectiveness, however, the exact relationship between self-efficacy and health outcomes has not been determined. In this dissertation research I investigate the evidence of a causal relationship between self-efficacy and three program outcomes (a decrease in depression, less pain, and a higher self-rating of overall health status), and attempt to determine the nature of that relationship. The research methodology involved the use of structural equation modeling (SEM) with two longitudinal samples, one (n=122) of 1991 ASMP participants in British Columbia, the other (n=189) of 1992 ASMP participants in Ontario. In the analysis self-efficacy was paired separately with depression, pain and perceived health status. The results of the SEM failed to confirm a dominant causal relationship from self-efficacy to depression, or to pain. This may indicate that these variables have a reciprocal or "spiral" relationship or that both sets of variables may be caused by factors not considered in the analysis. The results of the SEM between self-efficacy and perceived health status did, however, show that higher self-rated health status leads to higher self-efficacy at a later time. The data did not show statistical significance for other causal patterns among these variables. The findings suggest that self-efficacy may play a moderator role in the complex relationship involving individuals with arthritis, their behaviors, and health outcomes. As well, the findings have implications for health promotion planning and research in that they reinforce the complex interplay of psychological and behavioral variables (probably influenced by social variables) in programs which attempt to give individuals greater control over their health. The efficacy and effectiveness of the ASMP has been established in previous studies. This study in no way calls these into question. It does, however, suggest that the mechanism by which these effective outcomes are achieved warrants further investigation.

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Hollingshead, Nicole A. "An investigation of medical trainees' self-insight into their chronic pain management decisions." Thesis, 2014. http://hdl.handle.net/1805/4842.

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Indiana University-Purdue University Indianapolis (IUPUI)
While the majority of chronic pain patients report receiving inadequate care, there is evidence that female and Black patients receive less analgesic medications and treatment for their chronic pain compared to male and White patients, respectively. While treatment disparities have been evidenced in the literature, there is little understanding of provider-factors, such as their decision-making awareness and attitudes, which may contribute to the differences in treatment. This investigation employed quantitative and qualitative procedures to examine the relationship between patient demographics and chronic pain treatment variability, providers’ awareness of these non-medical influences on their decisions, and the extent to which providers’ gender and racial attitudes associate with their treatment decisions. Twenty healthcare trainees made pain treatment decisions (opioid, antidepressant, physical therapy, pain specialty referral) for 16 computer-simulated patients presenting with chronic low back pain; patient sex and race were manipulated across vignettes. Participants then selected among 9 factors, including patient demographics, to indicate which factors influenced their treatment decisions for the simulated patients and completed gender and racial attitude measures. After online study completion, follow-up semi-structured interviews were conducted to discuss the medical/non-medical factors that influence trainees’ clinical treatment decisions. Quantitative analysis indicated that 5%-25% of trainees were actually influenced (p<0.10) by patient sex and race in their treatments, and on the whole, trainees gave higher antidepressant ratings to White than Black patients (p<.05). Fifty-five percent demonstrated concordance, or awareness, between their actual and reported use of patient demographics. Follow-up McNemar’s test indicated trainees were generally aware of the influence of demographics on their decisions. Overall, gender and racial attitudes did not associate with trainees’ treatment decisions, except trainees’ complementary stereotypes about Black individuals were positively associated with their opioid decisions for White patients. During qualitative interviews, aware and unaware trainees discussed similar themes related to sex and racial/ethnic differences in pain presentation and tailoring treatments. We found that (1) a subset of trainees were influenced by patient sex and race when making chronic pain treatment decisions, (2) trainees were generally aware of the influence of patient demographics, and (3) trainees discussed differences in pain presentation based on patients’ sex and ethnic origin. These findings suggest trainees’ are influenced by patient demographics and hold stereotypes about patient populations, which may play a role in their decision-making.

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Dissertations / Theses on the topic 'Pain Self-management'

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