Dissertations / Theses on the topic 'Biopsychosocial model of chronic pain'

Psychological and contextual factors play an important role in the development and maintenance of chronic spine-related pain, and effective treatment of pain-related conditions requires an understanding of how these factors contribute to pain and disability. The present study examined the relative contributions of spine pathology, psychological complications, and demographic factors to perceived pain intensity and disability in patients with chronic spine-related pain. Because most patients were assessed in the context of a compensable injury, exaggeration of symptoms and disability was systematically controlled for using multiple validity indicators. A high prevalence of psychological complications was observed in the present sample. Analysis indicated that psychological factors were not significantly related to pain intensity, but were significantly related to reported pain-related disability. Further, psychological factors were found to predict pain-related disability beyond demographics, medical findings, and pain intensity. Clinical implications of these findings are discussed.

The current research examined the proposition that individuals who were securely attached had a fundamentally different reaction and experience of chronic pain to the experience of individuals with an insecure attachment style. A biopsychosocial model of chronic pain was created that included the variables of attachment style, pain, depression, anxiety, somatisation, quality of life, function, disability, neuroticism, age and gender. Three cross-sectional quantitative studies and one qualitative study were conducted. Participants were (a) patients from a multidisciplinary pain centre in a major public hospital, and (b) members of the general population with chronic pain who were recruited from both urban and rural settings, across various community support groups. The total sample was 470. Instruments for the quantitative studies included the Revised Adult Attachment Scale (Collins & Read, 1990), the McGill Pain Questionnaire (Melzack, 1975), the Pain Patient Profile (Tollinson & Langley, 1992), the Quality of Life Inventory (Frisch, 1994), the International Association for the Study of Pain Assessment Protocol (International Association for the Study of Pain, 1986), the Migraine Disability Scale (Stewart, Lipton, Kolodner, Liebermann, & Sawyer, 1999), and the short form of the Eysenck Neuroticism Scale (Eysenck, Eysenck, & Barret, 1985). The clinical and non-clinical participants with a diagnosis of chronic pain syndrome were partitioned as securely or insecurely attached. In the clinical sample, the proportion of securely attached individuals was less than one quarter of the group, while in the non-clinical sample the proportion of individuals in the securely attached group was 50%. For Study 1, (200 individuals from the clinical sample), the groups were partitioned using the classification criteria of Collins and Read (1990). Securely attached participants = 27%, insecurely attached 73%. An analysis of effect of attachment style on overall pain showed that the Securely Attached group reported less overall pain than the Insecurely Attached group. For Study 2, (using the total clinical sample), the sample comprised 27.3% securely attached and 72.7% insecurely attached participants. The Securely Attached group reported less overall Pain, less Negative Affect and Somatisation than the Insecurely Attached group, and higher levels of Quality of Life. Somatisation provided a significant unique contribution of variance to predicting overall Pain, providing some support for the biopsychosocial model, and Negative Affect (Depression and Anxiety combined) made a significant unique contribution to Quality of Life, explaining 26% of the variance. Gender was unrelated to any variable. For Study 3, the sample consisted of rural and urban participants, and the rural group was significantly older than the urban group. No other differences were found. The groups were combined to form the non-clinical group. The group was evenly divided (50%) between securely and insecurely attached groups. Gender was unrelated to any variable. For the non-clinical group, using the variables investigated in Study 2, there was no difference on overall pain scores, but negative affect and somatisation were higher and quality of life lower in the insecure group than in the secure group. No differences were found on Pain Intensity but Pain Pattern differed between the groups. Three new variables were added to the model - Neuroticism, Function and Disability. Disability and Function were significantly different between the attachment style groups. Age was significantly related to lower pain scores, less loss of function, less disability and higher quality of life. Pain scores were most related to somatisation, with age and quality of life contributing significant variance. Neuroticism added further to this explanation. Negative Affect made the most contribution to the variance explained in quality of life, and neuroticism and function made no significant contribution. Neuroticism and Attachment Style contributed significant amounts of variance to Function. To compare the Secure and Insecure Attachment groups in the Clinical and Non-clinical samples, a matched groups study, N = 190, was conducted. Clinical and non-clinical participants were matched for Age, Gender and Attachment Style. No differences were reported on overall pain between the attachment groups, but differences existed on negative affect, somatisation and quality of life. For sample type, the clinical group reported higher overall pain scores, less negative affect and less somatisation, but no differences were found on quality of life, compared to the non-clinical group. Study 4 was a qualitative study that used structured interviews of 24 clinical and non-clinical participants matched for age, gender, attachment style and etiology. The securely attached group reported having extensive, positive social support, high community involvement and appropriate reliance on medical and allied health care and medications. The insecurely attached group reported more problems with physical pain and psychological distress, less social support, less function and more perceived disability. The insecurely attached group reported more use of medical, allied and alternative health resources. Older securely attached individuals reported the lowest overall pain scores and the highest quality of life. These results support the hypotheses that a secure attachment style contributes to more positive outcomes for individuals with chronic pain syndrome and were consistent with a model of chronic pain that includes biological, psychological and social variables.

The current research examined the proposition that individuals who were securely attached had a fundamentally different reaction and experience of chronic pain to the experience of individuals with an insecure attachment style. A biopsychosocial model of chronic pain was created that included the variables of attachment style, pain, depression, anxiety, somatisation, quality of life, function, disability, neuroticism, age and gender. Three cross-sectional quantitative studies and one qualitative study were conducted. Participants were (a) patients from a multidisciplinary pain centre in a major public hospital, and (b) members of the general population with chronic pain who were recruited from both urban and rural settings, across various community support groups. The total sample was 470. Instruments for the quantitative studies included the Revised Adult Attachment Scale (Collins & Read, 1990), the McGill Pain Questionnaire (Melzack, 1975), the Pain Patient Profile (Tollinson & Langley, 1992), the Quality of Life Inventory (Frisch, 1994), the International Association for the Study of Pain Assessment Protocol (International Association for the Study of Pain, 1986), the Migraine Disability Scale (Stewart, Lipton, Kolodner, Liebermann, & Sawyer, 1999), and the short form of the Eysenck Neuroticism Scale (Eysenck, Eysenck, & Barret, 1985). The clinical and non-clinical participants with a diagnosis of chronic pain syndrome were partitioned as securely or insecurely attached. In the clinical sample, the proportion of securely attached individuals was less than one quarter of the group, while in the non-clinical sample the proportion of individuals in the securely attached group was 50%. For Study 1, (200 individuals from the clinical sample), the groups were partitioned using the classification criteria of Collins and Read (1990). Securely attached participants = 27%, insecurely attached 73%. An analysis of effect of attachment style on overall pain showed that the Securely Attached group reported less overall pain than the Insecurely Attached group. For Study 2, (using the total clinical sample), the sample comprised 27.3% securely attached and 72.7% insecurely attached participants. The Securely Attached group reported less overall Pain, less Negative Affect and Somatisation than the Insecurely Attached group, and higher levels of Quality of Life. Somatisation provided a significant unique contribution of variance to predicting overall Pain, providing some support for the biopsychosocial model, and Negative Affect (Depression and Anxiety combined) made a significant unique contribution to Quality of Life, explaining 26% of the variance. Gender was unrelated to any variable. For Study 3, the sample consisted of rural and urban participants, and the rural group was significantly older than the urban group. No other differences were found. The groups were combined to form the non-clinical group. The group was evenly divided (50%) between securely and insecurely attached groups. Gender was unrelated to any variable. For the non-clinical group, using the variables investigated in Study 2, there was no difference on overall pain scores, but negative affect and somatisation were higher and quality of life lower in the insecure group than in the secure group. No differences were found on Pain Intensity but Pain Pattern differed between the groups. Three new variables were added to the model - Neuroticism, Function and Disability. Disability and Function were significantly different between the attachment style groups. Age was significantly related to lower pain scores, less loss of function, less disability and higher quality of life. Pain scores were most related to somatisation, with age and quality of life contributing significant variance. Neuroticism added further to this explanation. Negative Affect made the most contribution to the variance explained in quality of life, and neuroticism and function made no significant contribution. Neuroticism and Attachment Style contributed significant amounts of variance to Function. To compare the Secure and Insecure Attachment groups in the Clinical and Non-clinical samples, a matched groups study, N = 190, was conducted. Clinical and non-clinical participants were matched for Age, Gender and Attachment Style. No differences were reported on overall pain between the attachment groups, but differences existed on negative affect, somatisation and quality of life. For sample type, the clinical group reported higher overall pain scores, less negative affect and less somatisation, but no differences were found on quality of life, compared to the non-clinical group. Study 4 was a qualitative study that used structured interviews of 24 clinical and non-clinical participants matched for age, gender, attachment style and etiology. The securely attached group reported having extensive, positive social support, high community involvement and appropriate reliance on medical and allied health care and medications. The insecurely attached group reported more problems with physical pain and psychological distress, less social support, less function and more perceived disability. The insecurely attached group reported more use of medical, allied and alternative health resources. Older securely attached individuals reported the lowest overall pain scores and the highest quality of life. These results support the hypotheses that a secure attachment style contributes to more positive outcomes for individuals with chronic pain syndrome and were consistent with a model of chronic pain that includes biological, psychological and social variables.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Psychology
Full Text

This thesis was concerned with determining the scope, nature and impact of pain on quality of life (QOL) among a community-based sample of people with multiple sclerosis (MS). An analysis of the research literature on pain in MS reveals that pain is a significant problem which has historically been underinvestigated and is currently poorly understood. The vast majority of the published literature consists of prevalence studies, descriptive research and clinical reports. Where available, empirical data are often limited by methodological and analytical problems such that substantive conclusions about the scope and nature of MS-related pain remain unclear. Among the most fundamental issues is the extent to which pain is problematic in a population which is already impaired by other physical disabilities. Little is known about how pain contributes to MS-related disability, distress and QOL. Moreover, research examining the psychosocial aspects of MS-related pain is noticeably absent. It is clear that there are substantial gaps in the literature and that many basic questions about the scope, nature and impact of pain problems among individuals with MS remain unanswered. Thus the primary aim of this study was to begin to fill some of these gaps by systematically investigating the following research questions: (1) What is the prevalence and nature of pain experienced by people with MS? (2) What is the impact of pain on the QOL of people with MS, over and above the impact of disability itself? (3) To what extent do physical and psychosocial factors influence adjustment to chronic pain in people with MS? (4) What meaning is given to the pain experience by people with MS? The present study utilised a multimethod research design involving cross-sectional postal survey, structured in-person pain interviews and focus groups. Survey respondents were a 219-person sample recruited from the Queensland MS Society membership database via systematic random sampling. All participants completed a piloted questionnaire containing questions about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the previous two weeks. Respondents who reported pain then completed face-to-face structured pain interviews assessing pain characteristics (viz. intensity, quality, location, extent and duration), pain-related beliefs and coping strategies, and pain management techniques used. Four focus groups were also conducted that included 32 people with MS living in the community. Study participants were a purposive sample drawn from four MS support groups located in the South-East Queensland region. Pain was found to be common with some 67.1% of the sample reporting pain during the two weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these individuals experience chronic pain conditions characterised by moderate-to-severe pain intensity. Pain prevalence and intensity were found to be strongly correlated with QOL: physical health, psychological health, level of independence and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. Pain-related beliefs and coping strategies were also associated with and explained a significant proportion of the variance in adjustment to pain among people with MS, over and above that accomplished by demographic and MS-related variables and pain intensity. Finally, qualitative data analysis revealed four broad conceptualisations of the experience of chronic MS-related pain including: pain is pervasive, nobody understands, I'm fine, and always a factor in the equation. These findings suggest that for people with MS, pain is an important source of distress and disability over and above that caused by neurological impairments. These data also lead to the hypothesis that recognition and effective treatment of pain would improve the QOL of people with MS, irrespective of their level of neurologic disability. Although correlational, the findings provide support for a biopsychosocial model of pain and adjustment to pain in people with MS.

This thesis was concerned with determining the scope, nature and impact of pain on quality of life (QOL) among a community-based sample of people with multiple sclerosis (MS). An analysis of the research literature on pain in MS reveals that pain is a significant problem which has historically been underinvestigated and is currently poorly understood. The vast majority of the published literature consists of prevalence studies, descriptive research and clinical reports. Where available, empirical data are often limited by methodological and analytical problems such that substantive conclusions about the scope and nature of MS-related pain remain unclear. Among the most fundamental issues is the extent to which pain is problematic in a population which is already impaired by other physical disabilities. Little is known about how pain contributes to MS-related disability, distress and QOL. Moreover, research examining the psychosocial aspects of MS-related pain is noticeably absent. It is clear that there are substantial gaps in the literature and that many basic questions about the scope, nature and impact of pain problems among individuals with MS remain unanswered. Thus the primary aim of this study was to begin to fill some of these gaps by systematically investigating the following research questions: (1) What is the prevalence and nature of pain experienced by people with MS? (2) What is the impact of pain on the QOL of people with MS, over and above the impact of disability itself? (3) To what extent do physical and psychosocial factors influence adjustment to chronic pain in people with MS? (4) What meaning is given to the pain experience by people with MS? The present study utilised a multimethod research design involving cross-sectional postal survey, structured in-person pain interviews and focus groups. Survey respondents were a 219-person sample recruited from the Queensland MS Society membership database via systematic random sampling. All participants completed a piloted questionnaire containing questions about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the previous two weeks. Respondents who reported pain then completed face-to-face structured pain interviews assessing pain characteristics (viz. intensity, quality, location, extent and duration), pain-related beliefs and coping strategies, and pain management techniques used. Four focus groups were also conducted that included 32 people with MS living in the community. Study participants were a purposive sample drawn from four MS support groups located in the South-East Queensland region. Pain was found to be common with some 67.1% of the sample reporting pain during the two weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these individuals experience chronic pain conditions characterised by moderate-to-severe pain intensity. Pain prevalence and intensity were found to be strongly correlated with QOL: physical health, psychological health, level of independence and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. Pain-related beliefs and coping strategies were also associated with and explained a significant proportion of the variance in adjustment to pain among people with MS, over and above that accomplished by demographic and MS-related variables and pain intensity. Finally, qualitative data analysis revealed four broad conceptualisations of the experience of chronic MS-related pain including: pain is pervasive, nobody understands, I'm fine, and always a factor in the equation. These findings suggest that for people with MS, pain is an important source of distress and disability over and above that caused by neurological impairments. These data also lead to the hypothesis that recognition and effective treatment of pain would improve the QOL of people with MS, irrespective of their level of neurologic disability. Although correlational, the findings provide support for a biopsychosocial model of pain and adjustment to pain in people with MS.

Background: Chronic pelvic pain (CPP) in women causes significant disability and distress. Like other chronic pain conditions, psychosocial variables likely play as key a role in the development and maintenance of CPP as physiological ones. The purposes of this study were to use the Biopsychosocial model to determine the predictors of pain and quality of life (QOL) and to specifically examine to effect of baseline catastrophizing on 12-month pain and QOL. Methods: Secondary analysis of baseline and 12-month data collected from women presenting for CPP treatment (n = 673) at a tertiary referral center was performed. Questionnaires assessed medical symptoms, physical and mental health, abuse, trauma, catastrophizing and the main outcome measures of pain reports (McGill Pain Questionnaire) and QOL scores (adapted version of the Irritable Bowel Syndrome QOL Questionnaire). Results: Of the 673 enrolled, 401 completed baseline questionnaires. These women were predominantly middle aged (M = 35.68, SD = 9.87), married (66%), Caucasian (78%), and educated (M = 14.83, SD = 2.55). Two hundred seventy-two women completed questionnaires at baseline and 12 months and were similar in most characteristics but reported fewer incidents of trauma and abuse, improved physical health and fewer medical symptoms. Women experienced a significant reduction in pain (t (261) = 11.23, p < .001) and improved QOL (t (257) = 6.78, p< .001). Baseline catastrophizing was a predictor of baseline pain (R2 = .42, pβ = .46, p < .001) and baseline QOL (R2 = .79, p< .001; β = .71 p < .001) with similar results at 12-month follow-up. While baseline catastrophizing contributed only 3% of the variance it remained a significant predictor of 12-month pain (R2 = .39, p < .001; β = .18, p = .003). Unexpectedly, abuse and trauma histories were not significant predictors of pain or QOL. Conclusions: These findings contribute to the existing body of literature by confirming the complex nature of CPP and suggest that psychological processes such as catastrophizing play a vital role in CPP. Future research in CPP will benefit from the exploration of the contribution of psychological processes to CPP and the application of research from other pain conditions to gynecologic pain disorders.

The present investigation examined the influence of cultural factors on Low Back Pain (LBP). Multiple regression techniques were used to determine the relative importance of clinical, social and psychological factors to LBP disability and cultural influences on these factors were then explored. The findings indicated that compared to clinical and social factors, LBP disability was most strongly associated with psychological factors (adjusted R2 change = 0.38, p<0.00), the most important of which was psychological distress. Clinical (adjusted R2 change = 0.11, p<0.00) or social (adjusted R2 change = 0.02, p=0.09) factors were only moderately or weakly associated with LBP disability. A series of hierarchical regression models examined the mediating role of cognitive Coping Strategies (Catastrophising & Praying and Hoping (Rosenstiel and Keefe (1983)) and Pain Control Beliefs (Control of Pain & Responsibility for management of Pain (Main and Waddell (1991)) on the relationship between LBP disability and distress. In support of the Cognitive Behavioural Mediational Model of chronic pain (Rudy and Turk, 1987), evidence was found to suggest that the relationship between LBP disability and distress was largely dependent upon Coping Strategies and Pain Control Beliefs. The findings also suggested that Pain Control Beliefs were largely dependent upon Coping strategies, although these relationships varied between specific Pain Control Beliefs and Coping Strategies. The study found evidence to suggest that certain self report questionnaires which are commonly used to assess cognitive factors associated with LBP may not have robust cross cultural reliabilities as measured by Cronbach's Alpha (Cronbach 1951) (Praying and Hoping (P&H) subscale of the Coping Strategies Questionnaire (CSQ) Rosensteil and Keefe 1983; Pain Responsibility (PR) subscale of the Pain Locus of Control (PLC) Main and Waddell 1991). The findings indicated that when used in their present form, these self reported questionnaires may provide inconsistent results with South Asian, African-born or Muslim LBP patients. The study provided evidence for the role of Cultural factors (self defined Ethnicity, Country of Birth and reported Religious Affiliation) on the experience of LBP. Although the relationship between cultural factors and LBP was generally weak (R2 change < 0.15), it appeared that South Asian, African-born and Muslim patients experienced LBP significantly worse than other LBP patients. The cultural group differences were strongest for the "passive" coping strategy "Praying and Hoping" (Rosensteil and Keefe 1983) (R2 change = 0.15, p < 0.001). The most apparent cultural differences were for Muslim patients who compared with all other Religious groups consistently reported the worst experience of LBP. Muslim LBP patients were clinically more disabled than either Christian (mean Roland and Morris Disability Questionnaire (RMDQ) difference (Roland and Morris, 1983) = 4.13) or other (mean RMDQ difference = 4.29) LBP patients. The statistical control of clinical variables in the regression models led to the conclusion that these groups of patients had a more "chronic" experience of LBP. Religious affiliation may help to identify LBP patients who present to secondary care with more chronic symptoms of LBP. Standardisation of self report questionnaire in these cultural groups may improve the precision of these findings. The present investigation was primarily descriptive in that reasons for cultural differences were not empirically examined. However the study findings suggest potentially fruitful areas for further investigation particularly that work on the meaning of "Praying" as a coping strategy and on its relationship with LBP disability for non-Christian groups would appear warranted.

Learning about biopsychosocial contributions to a sensitised pain system is a key target of many pain management programs for both adults and young people. The ‘Protectometer’ is a tool used to explore potential contributors, known as ‘danger in me’ (DIM) and ‘safety in me’ (SIM) cues. However, little is known about what topics are generated using the ‘Protectometer’, and to what extent these topics differ between young people and adults. A mixed-methods study was conducted to understand more about the types of danger and safety cues identified during pain management programs. Written ‘danger in me’ (n=504) and ‘safety in me’ (n=711) cues were collected from 96 participants (77 adults and 19 young people) who completed pain management programs across 15 groups at an adult or a young person pain centre. Reflexive thematic analysis identified four overarching themes: (1) Engaging with the environment, (2) In my body, (3) My emotional health, and (4) Activities and behaviours, with separate sub-themes for danger and safety cues. Codebook analysis of data into biological, psychological, or social domains was also performed. Integrating the results and comparing between age groups revealed differences between adults and young people for the most common types of danger cues, however safety cues were similar. Interestingly, the most common types of safety cues for both age groups were in the social domain. These findings highlight important areas to target in pain management education and treatment. They may help inform clinicians on key topics to address for each age group, and support the need to tailor interventions to age-specific clinical features. It also highlights the particular perceived relevance of social-based activities and environments in pain management therapies.
Thesis (Masters)
Master of Medical Research (MMedRes)
School of Pharmacy & Med Sci
Griffith Health
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Antecedents: el dolor lumbar és el problema musculoesquelètic més freqüent a tot el món. Fins a un 90% de pacients amb dolor lumbar no han rebut una explicació clara sobre la font i l'origen del seu dolor. Aquestes persones normalment reben un diagnòstic de dolor lumbar inespecífic. L'educació del pacient és una manera de donar informació i consell amb l'objectiu de modificar la cognició i el coneixement que aquests pacients tenen sobre el seu estat crònic. Això s'aconsegueix a través de la reducció de la por anticipatòria a les conseqüències i la represa de les activitats normals. Les tecnologies de la informació i els processos de comunicació associats es poden utilitzar com un mitjà per donar informació mèdica als pacients. Per tant, aquestes tecnologies i la seva capacitat per proporcionar informació vital ha crescut com una eina poderosa i alternativa per a la promoció de la salut. Diversos estudis han suggerit que les intervencions educatives basades en la web poden canviar i millorar el coneixement dels pacients crònics i tenir un impacte positiu en les actituds i conductes d'aquests pacients. Objectiu: L'objectiu d'aquest projecte va ser explorar les creences dels pacients respecte a l'origen i significat del seu dolor lumbar crònic per desenvolupar i avaluar una intervenció educativa biopsicosocial sobre el dolor al web utilitzant diferents formats educatius i tècniques de gamificació. Mètodes/disseny: Aquest estudi va fer servir un disseny mixt exploratori seqüencial. Un total de 48 pacients amb dolor lumbar crònic entre 20 i 65 anys d'edat que estaven rebent tractament en atenció primària van participar en aquest estudi. Per a la fase qualitativa de l'estudi, 16 subjectes (8 homes i 8 dones) van ser contactats pel seu metge de família i convidats a participar en una entrevista personal semiestructurada. La fase quantitativa es va estructurar com un assaig controlat aleatori paral·lel. La durada de la intervenció va ser de 15 dies. 48 xii subjectes van ser assignats a l'atzar utilitzant una tècnica de mostreig aleatòria simple. L'aleatorització i l'assignació als grups es van dur a terme mitjançant un sistema informàtic central. Els pacients i investigadors van ser cegats a l'assignació de grup. El grup d'intervenció (n = 26) va tenir accés a un lloc web on se'ls va proporcionar informació relacionada amb el seu dolor lumbar crònic. Aquesta informació va ser proporcionada en diferents formats. Tot aquest material es va basar en la informació obtinguda en la fase qualitativa. El grup control (n = 22) va seguir el tractament convencional proporcionat pel seu metge de família. La variable de resultat principal de l'estudi va ser la intensitat del dolor mesurada mitjançant una escala visual analògica de 0-100. Les variables de resultat secundàries van ser les creences de por-evitació, la kinesiofòbia i la discapacitat. Resultats: Es va realitzar una anàlisi per intenció de tractar (n = 44), usant una anàlisi factorial mixt. La interacció entre tractament i temps per a la intensitat del dolor va ser estadísticament no significatiu (F[1, 42] = 0.847, p = 0.36). La interacció entre tractament i temps va ser estadísticament significatiu per a les variables de resultat creences de por-evitació (F[1, 42] = 4.516, p = 0.04), kinesiofòbia (F[1, 42] = 5.388, p = 0.02) i discapacitat (F[1, 42] = 4.379, p = 0.04), amb resultats més favorables al grup experimental. A curt termini el grup experimental va mostrar unes diferències estadísticament significatives a favor seu en la discapacitat (MD -4.1; CI 95% -7.53 to -0.68; η2 = 0.11; p = 0.02), representant una mida de l'efecte mitjà. No es van trobar diferències estadísticament significatives en la intensitat del dolor, les creences de por-evitació i la kinesiofòbia entre els grups. Conclusions: Els pacients han expressat la necessitat de comprendre millor el seu dolor, el que implica que els professionals de la salut haurien de ser més didàctics en el tractament dels pacients amb dolor lumbar crònic. Una intervenció educativa biopsicosocial sobre el dolor al web per a pacients amb dolor lumbar crònic va demostrar ser més beneficiosa que el tractament convencional proporcionat pels metges de família en atenció primària sobre la discapacitat, encara que aquest resultat podria estar més relacionat amb les puntuacions de discapacitat més elevades mostrades pel grup control post-test que amb la millora obtinguda pel grup experimental. Registre de l'estudi: ClinicalTrials.gov NCT02369120 Data: 02/20/2015.
Antecedentes: el dolor lumbar es el problema musculoesquelético más frecuente en todo el mundo. Hasta un 90% de pacientes con dolor lumbar no han recibido una explicación clara sobre la fuente y el origen de su dolor. Estas personas comúnmente reciben un diagnóstico de dolor lumbar inespecífico. La educación del paciente es una manera de dar información y consejo con el objetivo de modificar la cognición y el conocimiento que estos pacientes tienen sobre su estado crónico. Esto se consigue a través de la reducción del miedo anticipatorio a las consecuencias y la reanudación de las actividades normales. Las tecnologías de la información y los procesos de comunicación asociados se pueden utilizar como un medio para dar información médica a los pacientes. Por lo tanto, estas tecnologías y su capacidad para proporcionar información vital ha crecido como una herramienta poderosa y alternativa para la promoción de la salud. Varios estudios han sugerido que las intervenciones educativas basadas en la web pueden cambiar y mejorar el conocimiento de los pacientes crónicos y tener un impacto positivo en las actitudes y conductas de estos pacientes. Objetivo: El objetivo de este proyecto fue explorar las creencias de los pacientes con respecto al origen y significado de su dolor lumbar crónico para desarrollar y evaluar una intervención educativa biopsicosocial sobre el dolor en la web utilizando diferentes formatos educativos y técnicas de gamificación. Métodos/diseño: Este estudio usó un diseño mixto exploratorio secuencial. Un total de 48 pacientes con dolor lumbar crónico entre 20 y 65 años de edad que estaban recibiendo tratamiento en atención primaria participaron en este estudio. Para la fase cualitativa del estudio, 16 sujetos (8 hombres y 8 mujeres) fueron contactados por su médico de familia e invitados a participar en una entrevista personal semiestructurada. La fase cuantitativa se estructuró como un ensayo controlado aleatorio paralelo. La duración de la intervención fue de 15 días. 48 sujetos fueron asignados al azar utilizando una técnica de muestreo aleatoria simple. La aleatorización y la asignación a los grupos se llevaron a cabo mediante un sistema informático central. Los pacientes e investigadores fueron cegados a la asignación de grupo. El grupo de intervención (n = 26) tuvo acceso a un sitio web donde se les proporcionó información relacionada con su dolor lumbar crónico. Esta información fue proporcionada en diferentes formatos. Todo este material se basó en la información obtenida en la fase cualitativa. El grupo control (n = 22) siguió el tratamiento convencional proporcionado por su médico de familia. La variable de resultado principal del estudio fue la intensidad del dolor medida mediante una escala visual analógica de 0-100. Las variables de resultado secundarias fueron las creencias de miedo-evitación, la kinesiofobia y la discapacidad. Resultados: Se realizó un análisis por protocolo (n = 44), usando un análisis factorial mixto. La interacción entre tratamiento y tiempo para la intensidad del dolor fue estadísticamente no significativo (F[1, 42] = 0.847, p = 0.36). La interacción entre tratamiento y tiempo fue estadísticamente significativo para las variables de resultado creencias de miedo-evitación (F[1, 42] = 4.516, p = 0.04), kinesiofobia (F[1, 42] = 5.388, p = 0.02) y discapacidad (F[1, 42] = 4.379, p = 0.04), con resultados más favorables al grupo experimental. A corto plazo el grupo experimental mostró unas diferencias estadísticamente significativas a su favor en la discapacidad (MD -4.1; CI 95% -7.53 to -0.68; η2 = 0.11; p = 0.02), representando un tamaño del efecto medio. No se encontraron diferencias estadísticamente significativas en la intensidad del dolor, las creencias de miedo-evitación y la kinesiofobia entre los grupos. Conclusiones: Los pacientes han expresado la necesidad de comprender mejor su dolor, lo que implica que los profesionales de la salud deberían ser más didácticos en el tratamiento de los pacientes con dolor lumbar crónico. x Una intervención educativa biopsicosocial sobre el dolor en la web para pacientes con dolor lumbar crónico demostró ser más beneficiosa que el tratamiento convencional proporcionado por los médicos de familia en atención primaria sobre la discapacidad, aunque este resultado podría estar más relacionado con los puntajes de discapacidad más elevados mostrados por el grupo control post-test que con la mejora obtenida por el grupo experimental. Registro del estudio: ClinicalTrials.gov NCT02369120 Fecha: 02/20/2015.
Background: Low back pain is the most frequently reported musculoskeletal problem worldwide. Up to 90 % of patients with low back pain have not received a clear explanation for the source and origin of their pain. These individuals commonly receive a diagnosis of non-specific low back pain. Patient education is a way to provide information and advice aimed at changing patients’ cognition and knowledge about their chronic state through the reduction of fear of anticipatory outcomes and the resumption of normal activities. Information technology and the expedited communication processes associated with this technology can be used to deliver healthcare information to patients. Hence, this technology and its ability to deliver life-changing information has grown as a powerful and alternative health promotion tool. Several studies have suggested that web-based educational interventions can change and improve the knowledge of patients with chronic pain and have a positive impact on their attitudes and behaviors. Objective: The aim of this project was to explore patients’ beliefs regarding the origin and meaning of their chronic low back pain in order to develop and evaluate a web-based biopsychosocial pain education intervention using different educational formats and gamification techniques. Methods/design: This study had a mixed-method sequential exploratory design. A total of 48 patients suffering from chronic low back pain between 20–65 years of age who were receiving treatment in a primary care setting in Spain, took part in this study. For the qualitative phase of the study, 16 subjects (8 men and 8 women) were contacted by their family physician and invited to participate in a personal semi-structured interview. The quantitative phase was structured as a parallel randomized controlled trial. The duration of the intervention was 15 days. 48 subjects were randomly allocated using a simple random sample technique. vi Randomization and allocation to trial group were carried out by a central computer system. Patients and researchers were blinded to group assignment. The intervention group (n = 26) had access to a specific website where they were given information related to their chronic low back pain. This information was provided in different formats. All of this material was based on the information obtained in the qualitative phase. The control group (n = 22) followed conventional care provided by their family physician. The main outcome variable was pain intensity measured using a 0-100 visual analogue scale. Secondary outcome measures were fear-avoidance beliefs, kinesiophobia, and disability. Results: A per-protocol analysis was carried out (n = 44) using a two-way mixed factorial analysis of variance. There was no statistically significant interaction between treatment and time for pain intensity (F[1, 42] = 0.847, p = 0.36). There was a statistically significant interaction between time and treatment for fear-avoidance beliefs (F[1, 42] = 4.516, p = 0.04), kinesiophobia (F[1, 42] = 5.388, p = 0.02), and disability (F[1, 42] = 4.379, p = 0.04) with more favorable results for the experimental group. In the short term, there was a statistically significant difference on disability favoring the experimental group (MD -4.1; CI 95% -7.53 to -0.68; η2 = 0.11; p = 0.02), representing a medium effect size. No statistically significant differences were found in pain intensity, fear-avoidance beliefs and kinesiophobia between groups. Conclusions: The patients have expressed the need to better understand their pain, which implies that health professionals should be more didactic in the management of patients with chronic low back pain. A web-based biopsychosocial pain education intervention for patients with chronic low back pain proved to be more beneficial than conventional care provided by family physicians in primary care on disability, although this result could be more related to the greater disability scores post-test in the control group rather than with the improvement obtained in the experimental group. Trial registration: ClinicalTrials.gov NCT02369120 Date: 02/20/2015.

Self-regulation is the capacity to exert control over cognition, emotion, behavior, and physiology. Since chronic pain interferes with the ability to self-regulate, the primary goal of this study was to examine, in rodents, the effects of chronic pain on self-regulation processes. Sixteen male Sprague-Dawley rats were divided into two groups: (1) chronic constriction injury of the infraorbital nerve (CCI-ION) and (2) naïve. Testing confirmed that CCI-ION animals had significant mechanical allodynia compared to naïve animals (p<0.001). A two-part self-regulation behavioral paradigm consisting of a cued go/no-go task and a subsequent persistence task was developed based on human paradigms. In the cued task, both groups made fewer incorrect lever presses in post-surgery trials (p<0.001); naive animals had a greater decrease in number of incorrect presses than CCI-ION animals (p=0.06). Similarly, both groups had a larger correct to total lever presses ratio in post-surgery trials (p<0.001); naïve animals had a greater increase than CCI-ION animals (p=0.06). In the persistence task, naïve animals experienced a greater decrease in lever presses (p=0.08) than did CCI-ION animals (p=0.66). These results suggest that animals experiencing chronic pain were not able to learn as well as naïve animals, and may have difficulty responding to novel environmental demands.

Background: Chronic widespread pain (CWP), the cardinal feature of the chronic pain disorder fibromyalgia, is prevalent in the general population. Psychosocial status has repeatedly been shown to be associated with the onset of CWP, yet it does not explain all new cases of the disorder and other risk factors have been implicated. Physically traumatic events, such as a road traffic accident (RTA) may "trigger" symptom onset. There is evidence from family and twin studies to suggest that there is a genetic component to CWP. Genetic association (GA) studies of fibromyalgia have been methodologically weak. The overall aim of this thesis was to examine the relative contribution of psychosocial factors, physically traumatic events, and specific genetic polymorphisms in the onset of CWP. Methods: The EPidemiology of FUNctional Disorders (EPIFUND) study, a prospective population-based study, was used. Subjects (aged 25-65 years) were recruited from three general practices in Northwest England. Information was collected via postal survey at three time points over four years. At baseline (T1), psychosocial status was assessed using a number of validated scales. Pain status was assessed at T1 and at both followups (carried out at 15 months (T2) and 47 months (T3». CWP was classified using standard American College of Rheumatology criteria. Subjects free of CWP at T1 and with new onset CWP at T2 or T3 were identified. Regression techniques were used to investigate the relationships between psychosocial factors and traumatic events and CWP onset. At T3, subjects were also asked to provide a buccal swab sample from which DNA was extracted. A nested case-control study was conducted to investigate the GA of CWP (cases: CWP at ~ two time points; controls: free of pain at all three time points). Logistic regression models were used to analyse the relationship between genotype data and the presence of CWP. Results: 68% of eligible subjects participated at T1 (n=6791). At T2 and T3 the adjusted participation rate was 82% (n=3912) and 81% (n=2723), respectively. The onset rate of CWP was 10% (n=283) and 8% (n=145) at T2 and T3, respectively. High illness behaviour, somatic symptom, sleep problem, and depression scores were independent predictors of CWP onset at both 15 and 47 months of follow-up. Physically traumatic events did not independently predict the onset of CWP, although reporting a bone fracture, RTA, or childbirth, was univariately associated with CWP onset. The GA study (cases, n=153; controls, n=167) identified a number of associations between CWP and polymorphisms in genes on the hypothalamic-pituitary-adrenal axis and serotoninergic system. A number of these associations were moderated by psychosocial status (anxiety and depression). Conclusions: A psychosocial model for CWP onset that predicts the onset of CWP up to four years later has been established. Physically traumatic events do not appear to be important in the onset of CWP. Novel GAs with CWP have been identified. These findings highlight the multifactorial nature of CWP.

Homeodynamic space (HDS) shrinks as vulnerability increases with aging and repeated damage to the cells. HDS is lost in alcoholic pancreatitis patients due to overconsumption of alcohol, smoking, and high fat diets. Etiologically relevant animal models for study of chronic pancreatitis (CP) are needed. In order to begin filling this gap a central purpose of this dissertation research was to examine relationships between the alcohol and high fat diet (AHF) and pancreatitis with attention to hypersensitivity and anxiety-like behaviors. The AHF diet induced pancreatitis described here etiologically mimics human risk factors of AHF consumption for advancement to alcoholic CP. In this study one group of mice was fed long term with a diet of high fat and alcohol for comparison with a group fed normal chow. Mice consumed a liquid diet containing 6% alcohol and a high fat supplement ad libitum over a period of five months. Each group was evaluated for heat and mechanical hypersensitivity, and histology indicative of CP. The association of pancreatitis pathology with anxiety has been understudied. Anxiety, like pain, is useful as a transient state but when anxiety is prolonged it is termed a disorder. Anxiety is often comorbid with pain and depression. Therefore, it is important to determine anxiety in mice with CP histology. This model was characterized for the interaction of pancreatitis histology, as well as persisting pain-, anxiety-, and fear-like behaviors. The AHF diet mice developed hypersensitivity, demonstrated anxiety-like behaviors, and showed concurrent histology consistent with CP. Nontransgenic mouse models where pancreatitis is induced only by a combination of ad libitum liquid food with added alcohol and lard supplementation do not currently exist, nor has an in-depth study of anxiety-like behaviors been conducted in this mouse model. This dissertation research addresses this knowledge gap.

The rates of opioid prescription and use have continued to increase over the last few decades. In turn, a greater number of patients suffer from opioid tolerance. Treatment of acute pain is a clinical challenge for these patients. Acute pain can arise from common occurrences like surgical pain and pain resulting from the injury. P-glycoprotein (p-gp) is a transporter at the blood-brain barrier (BBB) associated with a decrease in the analgesic efficacy of morphine. Peripheral inflammatory pain (PIP) is a pain state known to cause a change in p-gp trafficking at the BBB. P-gp traffics from the nucleus to the luminal surface of endothelial cells making up the BBB. This surface where circulating blood interfaces with the endothelial cell is where p-gp will efflux morphine back into circulation. Osmotic minipumps were used as a long-term delivery method in this model of opioid tolerance in female rats. PIP induced p-gp trafficking away from nuclear stores showed a 2-fold increase when animals were exposed to opioids for 6 days. This observation presents a possible relationship between p-gp trafficking and the challenges of treating post-surgical pain in opioid tolerant patients. This could reveal potential strategies for improving pain management in these patients.

The purpose of this phenomenological study was to understand the lived experience of adolescents who live with chronic pain. All 10 participants were between the ages of 13 and 17 and have lived with chronic pain for at least 6 months. Data sources for the study were two interviews for each participant, participant drawn depictions of their chronic pain, and researcher journaling. The person-environment-occupation model was used to frame the research design. The study found four main themes among the data: pain identity, invisible disease, occupational loss, and uphill climb to regain life. Each theme described the essence of the common experience of adolescents living with chronic pain. Occupational therapists can benefit from incorporating this knowledge base into their practice when providing intervention for individuals living with chronic pain to improve their overall quality of life and occupational performance.

This program of research examines the experience of chronic pain in a community sample. While, it is clear that like patient samples, chronic pain in non-patient samples is also associated with psychological distress and physical disability, the experience of pain across the total spectrum of pain conditions (including acute and episodic pain conditions) and during the early course of chronic pain is less clear. Information about these aspects of the pain experience is important because effective early intervention for chronic pain relies on identification of people who are likely to progress to chronicity post-injury. A conceptual model of the transition from acute to chronic pain was proposed by Gatchel (1991a). In brief, Gatchel’s model describes three stages that individuals who have a serious pain experience move through, each with worsening psychological dysfunction and physical disability. The aims of this program of research were to describe the experience of pain in a community sample in order to obtain pain-specific data on the problem of pain in Queensland, and to explore the usefulness of Gatchel’s Model in a non-clinical sample. Additionally, five risk factors and six protective factors were proposed as possible extensions to Gatchel’s Model. To address these aims, a prospective longitudinal mixed-method research design was used. Quantitative data was collected in Phase 1 via a comprehensive postal questionnaire. Phase 2 consisted of a follow-up questionnaire 3 months post-baseline. Phase 3 consisted of semi-structured interviews with a subset of the original sample 12 months post follow-up, which used qualitative data to provide a further in-depth examination of the experience and process of chronic pain from respondents’ point of view. The results indicate chronic pain is associated with high levels of anxiety and depressive symptoms. However, the levels of disability reported by this Queensland sample were generally lower than those reported by clinical samples and consistent with disability data reported in a New South Wales population-based study. With regard to the second aim of this program of research, while some elements of the pain experience of this sample were consistent with that described by Gatchel’s Model, overall the model was not a good fit with the experience of this non-clinical sample. The findings indicate that passive coping strategies (minimising activity), catastrophising, self efficacy, optimism, social support, active strategies (use of distraction) and the belief that emotions affect pain may be important to consider in understanding the processes that underlie the transition to and continuation of chronic pain.

This program of research examines the experience of chronic pain in a community sample. While, it is clear that like patient samples, chronic pain in non-patient samples is also associated with psychological distress and physical disability, the experience of pain across the total spectrum of pain conditions (including acute and episodic pain conditions) and during the early course of chronic pain is less clear. Information about these aspects of the pain experience is important because effective early intervention for chronic pain relies on identification of people who are likely to progress to chronicity post-injury. A conceptual model of the transition from acute to chronic pain was proposed by Gatchel (1991a). In brief, Gatchel’s model describes three stages that individuals who have a serious pain experience move through, each with worsening psychological dysfunction and physical disability. The aims of this program of research were to describe the experience of pain in a community sample in order to obtain pain-specific data on the problem of pain in Queensland, and to explore the usefulness of Gatchel’s Model in a non-clinical sample. Additionally, five risk factors and six protective factors were proposed as possible extensions to Gatchel’s Model. To address these aims, a prospective longitudinal mixed-method research design was used. Quantitative data was collected in Phase 1 via a comprehensive postal questionnaire. Phase 2 consisted of a follow-up questionnaire 3 months post-baseline. Phase 3 consisted of semi-structured interviews with a subset of the original sample 12 months post follow-up, which used qualitative data to provide a further in-depth examination of the experience and process of chronic pain from respondents’ point of view. The results indicate chronic pain is associated with high levels of anxiety and depressive symptoms. However, the levels of disability reported by this Queensland sample were generally lower than those reported by clinical samples and consistent with disability data reported in a New South Wales population-based study. With regard to the second aim of this program of research, while some elements of the pain experience of this sample were consistent with that described by Gatchel’s Model, overall the model was not a good fit with the experience of this non-clinical sample. The findings indicate that passive coping strategies (minimising activity), catastrophising, self efficacy, optimism, social support, active strategies (use of distraction) and the belief that emotions affect pain may be important to consider in understanding the processes that underlie the transition to and continuation of chronic pain.

This thesis explores treatment satisfaction and dissatisfaction in patients with chronic low back pain (CLBP). Chapters 1 and 2 provide background on CLBP, and treatment satisfaction and dissatisfaction. Chapter 3 presents study 1, the systematic review which identified research concerning treatment satisfaction and dissatisfaction in patients with CLBP. Findings indicated a need to define the concept, and establish appropriate measurement based on patient input and evidence to support the reliability and validity of items. Chapter 4 presents study 2, a qualitative study. Ten patients with CLBP taking medication and/or receiving physiotherapy were interviewed. A conceptual model of CLBP and a thematic map of treatment satisfaction and dissatisfaction were developed. Satisfaction was related to being 'happy' or 'pleased', and maintaining normal functioning. Treatment not working, causing discomfort, or negatively affecting health-related quality of life, as well as inconvenience of medication, lack of information, not feeling involved in treatment decisions, lack of trust and confidence in healthcare professionals, and being misdiagnosed or undiagnosed, were associated with dissatisfaction. Chapter 5 documents the development of the CLBP Treatment Satisfaction Questionnaire, based on patient input from study 2. Cognitive debriefing showed items were relevant and understood by patients. Chapter 6, study 3, explored the psychometric properties of the questionnaire. The longitudinal design involved data collection from 249 patients, some of whom participated in follow-ups. Results indicated that treatment satisfaction/dissatisfaction involves an appraisal of the following seven domains: 'Information Provided about Back Pain and Treatment', 'Burden of Back Pain', 'Impact of Back Pain and Treatment on Relationships', 'Satisfaction with the Treatment Process', 'Problems with Side Effects of Medication', 'Adherence to Physiotherapy', and 'Medication Acceptability'. Some evidence of reliability and validity are presented. This thesis concludes with Chapter 7, a discussion of the main findings of the studies, strengths and limitations, and recommendations for future research.

Understanding underlying mechanisms and pathways that lead to chronic homelessness would help develop intervention strategies that could help prevent subsequent episodes of homelessness. Quantitative data for this cross-sectional study was gathered by interviewing individuals who were homeless in the State of Arkansas, using a structured survey between 2007 and 2011. Qualitative data was gathered using semi-structured interviews between 2016 and 2018. Chi-square statistics and a multivariate logistic regression model was used to analyze the quantitative data, while phenomenological methods were used to analyze the qualitative data. Nearly half of the study participants identified themselves as being chronically homeless. Chronically homeless adults in this region were significantly more likely to be older men with no family ties, more likely to be victims of domestic violence, have higher rates of physical health problems, and have alcohol and substance abuse problems. Results from the multivariate nominal regression revealed that individuals who reported themselves as chronically homeless were more likely to be in the 50 years or older age group. In addition, study findings highlighted a dynamic interplay between three biopsychosocial risk factors for homelessness. Fostering development of inclusive sustainable communities, intergenerational relationships, and shared housing practices could help ease such social inequities and prevent problems such as chronic homelessness in older homeless adults.

Complex regional pain syndrome (CRPS) is a severe neuropathic-like chronic pain disorder that is characterized by spontaneous and stimulus-evoked pain, vascular abnormalities, sudomotor changes, and muscle and bone abnormalities. Growing evidence suggests that ischemic processes may be particularly important pain mechanisms in CRPS, particularly for CRPS-type I, for which a major nerve injury is not indicated. Chronic ischemia in limbs of CRPS patients may underlie the analgesic effectiveness of anti-sympathetic treatments and vascular abnormalities. Since most animal models of neuropathic pain involve injury of a major nerve, development and characterization of an animal model that mimicks signs and symptoms of CRPS by an ischemic injury would increase our understanding of the mechanisms underlying CRPS-I. After a 3-hour tourniquet-induced ischemia and reperfusion of the rat hind paw (chronic post-ischemia pain; CPIP), a majority of animals develop chronic pathology that mimicks CRPS-I, with long-lasting sensory symptoms of mechanical allodynia, mechanical hyperalgesia, and cold allodynia following short-lasting signs of hyperemia and oedema. Chemical sympathectomy and phentolamine reduce signs of mechanical allodynia, suggesting this animal model exhibits what has been clinically defined as sympathetically-maintained pain (SMP). Further, the systemic administration of an α1-adrenergic antagonist, an α2-adrenergic agonist, a nitric oxide (NO) donor, but not an α2-adrenergic antagonist, also reduce mechanical allodynia, suggesting that vasodilation may be a way to relieve allodynia in this animal model. The relationship between mechanical allodynia and painful reactions to intracutaneous norepinephrine (NE) injection was also measured behaviourally, and was compared with changes in NE-induced reductions in hind paw blood flow in CPIP rats. As in CRPS patients with SMP, intradermal injection of NE into the affected hind paw induced dose-dependent nociceptive
Le syndrome douloureux régional complexe (SDRC) est une douleur chronique sévère semblable à la douleur neuropathique, et se caractérise par la présence de douleur spontanée et évoquée par stimulation, des anomalies vasculaires, des changements sudomoteurs et des anomalies ossseuses et musculaires. Les recherches récentes suggèrent que les processus d'ischémie sont impliqués dans les mécanismes de la douleur du syndrome SDRC et particulièrement pour le syndrome SDRC de type I, dans lequel il n´y a pas de lésion de nerf majeure identifiable. On pense que l'ischémie chronique dans les membres des patients SDRC est reliée à l'efficacité des traitements anti-sympathetiques analgésique et aux anormalités vasculaires présentes. Puisque la majorité des modèles animaux de la douleur neuropathique se caractérisent par une lésion de nerf majeur, on suggère que pour mieux comprendre les mécanismes pathologiques du SDRC-type I, il est necessaire de déveloper et de caractériser un nouveau modèle animal de la douleur chronique induie par une bléssure ischémique et qui reproduit les signes et les symptomes du SDRC de type-I. Un épisode d´ischémie suivi de réperfusion de la patte du rat par tourniquet pendant 3 heures cause chez une majorité d´animaux une pathologie chronique qui resemble au syndrome SDRC-type I (douleur chronique post-ischémique; DCPI), avec des symptomes sensoriels de longue durée comme l'allodynie tactile, l'hyperalgésie tactile, l'allodynie au froid, et aussi de l'hyperhémie et de l'oedème de courte durée. La sympathéctomie chimique et la phéntolamine diminuent les signes d'allodynie, ce qui demontre de la douleur en composant sympathique (SMP) dans ce modèle animal. En plus, l'administration systémique d'un antagoniste α1-adrénergique, d'un agoniste α2-adrénergique, d'un doneur de l'oxyde nitrique, mais pas d'un antagoniste α2-adrenergique diminue l'allodynie tactile, ce qui suggère que la vasodilata

Objectives: Theoretical models have helped conceptualise how individuals appraise and make sense of chronic illness and its psychological impact. Little attention has been given to the impact of uncertainty on this process. The objective was to investigate the relationship between levels of uncertainty, illness representations, coping, psychological and physical functioning in two chronic illnesses. The Self-Regulatory Model (SRM, Leventhal, Meyer & Nerenz, 1980) was used as a theoretical framework. Design: A cross-sectional design was used. It was hypothesised that a clear medical diagnosis would reduce levels of uncertainty and increase illness representations regarding control of symptoms. It was also hypothesised that high levels of uncertainty would independently predict increased psychological distress. Method: Patients suffering from chronic spinal pain and rheumatoid arthritis were recruited from local clinical departments. The levels of uncertainty, illness representations, coping strategies, mood and physical functioning of 85 participants were assessed using standardised questionnaires. Results: Chronic pain patients were found to have greater levels of uncertainty and psychological distress than rheumatoid arthritis patients. Rheumatoid arthritis patients had stronger beliefs about control of their condition. Uncertainty was not found to be a significant independent predictor of anxiety or depression. However, there appeared to be a degree of overlap between the variables of uncertainty and control beliefs. Conclusions: The findings highlight a complex relationship between the aspects of the SRM and uncertainty, with many components impacting on each other. Although levels of uncertainty were not found to be predictive of psychological distress, it is an area that warrants further investigation in order to understand how patients manage uncertainty. Within a clinical setting, issues of uncertainty should be addressed at all levels of care, maximising the patient's control beliefs, reducing the impact of uncertainty on their cognitive, emotional and physical functioning.

Understanding underlying mechanisms and pathways that lead to chronic homelessness would help develop intervention strategies that could help prevent subsequent episodes of homelessness. Quantitative data for this cross-sectional study was gathered by interviewing individuals who were homeless in the State of Arkansas, using a structured survey between 2007 and 2011. Qualitative data was gathered using semi-structured interviews between 2016 and 2018. Chi-square statistics and a multivariate logistic regression model was used to analyze the quantitative data, while phenomenological methods were used to analyze the qualitative data. Nearly half of the study participants identified themselves as being chronically homeless. Chronically homeless adults in this region were significantly more likely to be older men with no family ties, more likely to be victims of domestic violence, have higher rates of physical health problems, and have alcohol and substance abuse problems. Results from the multivariate nominal regression revealed that individuals who reported themselves as chronically homeless were more likely to be in the 50 years or older age group. In addition, study findings highlighted a dynamic interplay between three biopsychosocial risk factors for homelessness. Fostering development of inclusive sustainable communities, intergenerational relationships, and shared housing practices could help ease such social inequities and prevent problems such as chronic homelessness in older homeless adults.

[Truncated abstract] Despite significant scientific advances in tracking the complex physiological mechanisms that drive the asthma disease process, worldwide trends in childhood asthma continue to rise. This research sought to describe the relationships between psychosocial stress, psychosocial resources, asthma severity, and health-related outcomes from the standpoints of biopsychosocial and developmental theory. The research consisted of three studies based on a prospective study involving 2573 children from a community-based birth cohort. The cohort has been under active follow-up from birth and this thesis draws on data obtained at the 1, 2, 6, 10 and 13 year follow-ups . . . The final study undertook to describe the mediating influence of specific supportive behaviours provided by family members and peers to adolescents with asthma. Ninety-nine adolescents participating in the 13 year follow-up of the community cohort study completed a semi-structured interview adapted from the Diabetes Social Support Interview (La Greca et al., 1995) to assess supportive behaviours and the KINDL (Ravens-Sieberer & Bullinger, 1998) to assess QOL. It was predicted that illness-specific support would mediate the relationship between family dysfunction and quality of life. Qualitative analyses identified parents as important sources of tangible support, peers as important sources of companionship and emotional support, and siblings bridging the two, by providing tangible, companionship and emotional support to the adolescent. Mediator analyses found that specific parent behaviours perceived as unsupportive by the adolescent mediated the relationship between family dysfunction and self-oriented quality of life. Clinical implications support the integration of medical and psychological expertise in the treatment of asthma. Future research directions are also discussed.

The studies presented in this thesis are concerned with physiological and neurochemical characterization of on-going and stimulation-elicited synaptic transmission of sensory information in the dorsal horn of the rat spinal cord.
Historically, since the use of willow tree bark extract for pain relief, the recognition that it and related nonsteroidal anti-inflammatory drugs (NSAIDs) express their analgesic and anti-inflammatory effects by inhibiting cyclooxygenase (COX) and more recently the identification of two forms of COX, inducible (COX-2) and constitutive (COX-1), efforts have focussed on exploring the therapeutic potential of this class of drugs.
In normal rats, the response to noxious peripheral stimulation involves at least two distinct discharge responses of dorsal horn neurones, an initial discharge which lasts only for the duration of the stimulus and a slowly-decaying afterdischarge which persists beyond the end of the stimulus. Innocuous mechanical stimulation produces excitation of dorsal horn neurones lasting only for the duration of the stimulus. Characterization of these excitatory responses reveals that the initial discharge in response to noxious or innocuous mechanical stimulation involves only limited activation of the eicosanoid pathway via COX, while the afterdischarge is sustained to a major extent via COX activation, at least in part by COX-2. On-going discharge seems not to involve activation of COX.
An animal model of neuropathic pain was induced by implantation of a 2 mm polyethylene cuff around one sciatic nerve in rats. This lowers the nociceptive threshold in the von Frey hair test and induces spontaneous pain behaviour. In cuff-implanted rats, on-going activity is greater compared to that in normal rats. Furthermore, noxious mechanical stimulation evokes an afterdischarge response of dorsal horn neurones which is markedly greater than that in normal rats but the initial discharge is not different. Importantly, a switch in the response to innocuous mechanical stimulation is observed also such that an afterdischarge occurs after the end of the initial discharge, which is not seen in normal rats.
Characterization of the synaptically-elicited responses in cuff-implanted rats to noxious and innocuous mechanical stimulation reveals that the initial discharge, and to a greater extent the afterdischarge, are subject to a COX-2-mediated or modulatory mechanism. The elevated on-going discharge in cuff-implanted rats may also be sustained via tonic COX-2 activity.
These results demonstrate participation of unique and identifiable physiological and neurochemical mechanisms in the mediation and modulation of on-going and synaptically-elicited responses in the dorsal horn of the spinal cord in normal sensory processing and in sensory processing associated with peripheral neuropathy. Ultimately, the data in this thesis may advance understanding of the neurophysiological basis of chronic pain syndromes.

The work in this thesis concerns mechanisms of excitability of neurons. Specifically, it deals with how neurons respond to input, and how their response is controlled by ion channels and other active components of the neuron. I have studied excitability in two systems of the nervous system, the hippocampus which is responsible for memory and spatial navigation, and the peripheral C–fibre which is responsible for sensing and conducting sensory information to the spinal cord. Within the work, I have studied the role of excitability mechanisms in normal function and in pathological conditions. For hippocampus the normal function includes changes in excitability linked to learning and memory. However, it also is intimately linked to pathological increases in excitability observed in epilepsy. In C–fibres, excitability controls sensitivity to responses to stimuli. When this response becomes enhanced, this can lead to pain. I have used computational modelling as a tool for studying hyperexcitability in neurons in the central nervous system in order to address mechanisms of epileptogenesis. Epilepsy is a brain disorder in which a subject has repeated seizures (convulsions) over time. Seizures are characterized by increased and highly synchronized neural activity. Therefore, mechanisms that regulate synchronized neural activity are crucial for the understanding of epileptogenesis. Such mechanisms must differentiate between synchronized and semi synchronized synaptic input. The candidate I propose for such a mechanism is the fast outward current generated by the A-type potassium channel (KA). Additionally, I have studied the propagation of action potentials in peripheral axons, denoted C–fibres. These C–fibres mediate information about harmful peripheral stimuli from limbs and organs to the central nervous system and are thereby linked to pathological pain. If a C–fibre is activated repeatedly, the excitability is altered and the mechanisms for this alteration are unknown. By computational modelling, I have proposed mechanisms which can explain this alteration in excitability. In summary, in my work I have studied roles of particular ion channels in excitability related to functions in the nervous system. Using computational modelling, I have been able to relate specific properties of ion channels to functions of the nervous system such as sensing and learning, and in particular studied the implications of mechanisms of excitability changes in diseases.

QC 20102423

Background: Many studies in non-Asian contexts have tested psychological approaches in the treatment of chronic pain. However studies in Asia, including Singapore are few. Aims: This thesis is part of a program of research in the development of an Acceptance and Commitment Therapy (ACT)-based treatment for chronic pain, in its application within an Asian and specifically Singaporean cultural and healthcare context. Methods: Four distinct phases using a mixed-methods design approach was conducted: (a) A systematic review on the efficacy of psychological treatments for chronic pain in East and Southeast Asia (b) Assessing with semi-structured interviews, patient (N = 15) and health professional views (N = 15) on potential barriers for psychological treatment for chronic pain in Singapore, and views relevant to designing a successful ACT-based treatment for chronic pain (c) Identifying optimal delivery features in a quantitative survey developed from themes generated from the interviews, and a test of the relevance of ACT-related psychological processes in a wider patient sample (N = 200), and (d) Development and feasibility test of a culturally-adapted internet-based ACT trial (N = 33). Results: Studies included in the systematic review were few and mostly of low quality. Patients and health professionals shared many similar views on psychological treatment barriers and facilitators. Survey results showed that a focus on costs and providing proof of treatment success may increase psychological treatment uptake. The utility of psychological flexibility (PF) was found to be relevant within the sample of chronic pain patients from Singapore. High treatment satisfaction (81.8%), low dropout rates (9.1%) and significant effects on depression (0.51) and pain intensity (0.39) were demonstrated in the trial. Conclusions: A culturally-adapted ACT-based treatment examined in the healthcare context of Singapore appears feasible for future development. More effective ways to target outcomes and ACT processes are required.

Individuals born with primary immune deficiency diseases (PIDD) have a dysfunctional immune system, and many are treated by lifelong injections of immunoglobulin therapy. Studies have shown that these patients have low health-related quality of life (HRQOL) and well-being (WB) and that these outcomes might be improved by the availability of therapy innovated according to preferences for fewer needle sticks or a shorter infusion time. Regulators at the U.S. Food and Drug Administration (FDA) have approved therapies innovated per these preferences. However, there is limited data demonstrating how these innovations impact HRQOL and WB. Using the biopsychosocial model, the purpose of this cross sectional quantitative study was to evaluate whether patients with PIDD using therapies innovated for fewer needle sticks or a shorter infusion time had a higher mean HRQOL and WB compared to those who were not. The study included 153 patients who completed the Patient Reported Outcomes Measurement Information System (PROMIS)-29 survey. The dependent variables were HRQOL and WB measured by PROMIS-29, and the independent variables were the medical product innovations. Independent samples t tests results showed mean PROMIS-29 scores were not statistically different (p > .05). This suggests patients were optimized according to their treatment preference. A subgroup of patients who had taken the PROMIS-29 survey more than once concurrent with switching to a therapy aligned with patient preferences showed improved HRQOL and WB. These findings have implications for positive social change in that seeking the patient's voice to inform medical product innovation and FDA regulatory decision-making has potential to improve biopsychosocial outcomes.

Masters Research - Master of Philosophy (MPhil)
Biopsychosocial factors are increasingly recognised as important factors in the treatment of chronic pain. This pilot study seeks to identify those psychosocial factors that impact successful treatment outcomes of chronic pain in patients attending a 2 week intensive pain management program. Treatment targeted beliefs, psychological distress (trauma, anxiety and depression), and disability associated with chronic pain. The DASS-21 and Chronic Pain Acceptance questionnaires administered prior to, at completion of, and at 12 weeks post treatment revealed a significant decrease in depression and a significant increase in pain acceptance respectively and maintained over the 12 weeks. The Pain Beliefs Questionnaire results showed significant change in pain beliefs post treatment, however, this was not maintained at 12 weeks post treatment. Outcomes related to biopsychosocial factors, with age positively correlating with gains in acceptance, and number of interventions attempted correlating with poorer reductions in depression. Changes in pain beliefs and maintenance of those changes had a relationship with the distress from previous interventions and surgery. However, of interest in this study were client factors influencing treatment outcomes for example hope, prior beliefs, and acceptance. Both qualitative and quantitative future studies would broaden our understanding of common factors impacting the management of chronic pain.

abstract: Despite the strong link between pain and depressive symptoms, the mechanisms by which they are connected in the everyday lives of individuals with chronic pain are not well understood. In addition, previous investigations have tended to ignore biopsychosocial individual difference factors, assuming that all individuals respond to pain-related experiences and affect in the same manner. The present study tried to address these gaps in the existing literature. Two hundred twenty individuals with Fibromyalgia completed daily diaries during the morning, afternoon, and evening for 21 days. Findings were generally consistent with the hypotheses. Multilevel structural equation modeling revealed that morning pain and positive and negative affect are uniquely associated with morning negative pain appraisal, which in turn, is positively related to pain’s activity interference in the afternoon. Pain’s activity interference was the strongest predictor of evening depressive symptoms. Latent profile analysis using biopsychosocial measures identified three theoretically and clinically important subgroups (i.e., Low Functioning, Normative, and High Functioning groups). Although the daily pain-depressive symptoms link was not significantly moderated by these subgroups, individuals in the High Functioning group reported the lowest levels of average morning pain, negative affect, negative pain appraisal, afternoon pain’s activity interference, and evening depressive symptoms, and the highest levels of average morning positive affect across 21 days relative to the other two groups. The Normative group fared better on all measures than did the Low Functioning group. The findings of the present study suggest the importance of promoting morning positive affect and decreasing negative affect in disconnecting the within-day pain-depressive symptoms link, as well as the potential value of tailoring chronic pain interventions to those individuals who are in the greatest need.
Dissertation/Thesis
Doctoral Dissertation Psychology 2018

Childhood obesity has been prevalent for a number of years despite programs designed to educate children and families on healthy diets and activities. Multiple disciplines have reported chronic stress can interfere with normal neuroendocrine functions in the body which include energy balance. Research into alternate mechanisms contributing to childhood obesity is just beginning to include psychosocial factors’ and their influence on biology. Healthy coping strategies can reduce the effects of stress and influence perceptions of what is stressful. Warm, secure relationships with parents, family connectedness, and a secure stable environment all contribute to the buffering of chronic stress as well as promote the ability to cope with stress. Through the years, changes in the family environment through divorce, single parenthood, and cohabitation may play a role in the child’s ability to cope with stress. Therefore, the purpose of this study was to explore relationships between the child’s perceptions of chronic stress, coping strategies, family connectedness, family characteristics, and weight in 4th and 5th grade children. This study used a cross sectional and correlational design. The conceptual framework guiding this study was the Bio-Psycho-Social Model for Health integrating the three dimensions (biological, psychological, and sociological) as they relate to obesity in children. Well established instruments were used to measure chronic stress, coping, family connectedness, and weight. Results did not reveal a relationship between chronic stress and children’s weights. The ‘frequency the family sat down to eat dinner together’ was significantly related to weight: the more dinners together the lower the body mass indices and accounted for 14.7% variance in children’s body mass indices. Frequency of family meals was also correlated with the frequency of cooking dinner and negative trending of both ‘frequency’ and ‘helpfulness’ of coping strategies: possibly suggesting less need for the coping strategies. Parents’ education was positively correlated with more sleep on school nights for children. The findings suggest the importance of family time together is related to lower body mass indices in children.
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碩士
元智大學
資訊管理研究所
91
Not like cancers that will cause the people die, it will be influence the quality of life of the patients with low back pain (LBP). At least 47% to 90% people will get low back pain in whole of his life. Most people ignored the influence and the impacts of the health that cause by the LBP. Actually, people will not die because of the LBP. But it will influence widely, especial the quality of life (QOL). The chronic LBP usually comes from acute stage. About 30% LBP patients will spend more than 80% of the costs that used on low back pain. The researches of chronic LBP will focus 4 aims: The severity of disease, the impact of the emotion, the disability that cause by LBP, and the influences of the QOL. The LBP has many risk factors and these assessments of the chronic LBP divides into 5 parts: the QOL, psychological factors, work relates, pain relates, physical factors. The Oswestry Disability Index, (ODI), Pain assessment of visual analog scale (P-VAS), 36-item short-form health survey (SF-36), Chinese Health Questionnaire (CHQ-12) are included. The data were for evaluating and finding the correlations between the quality of life, some scales and chronic LBP with multiple linear regressions and clustering technologies. The thresholds of these scales that define the chronic LBP are also presented. It included that ODI≧30, SF-36<375, CHQ-12≧2, GDS≧18 with significance (p<0.01). Build a model with these scales to predict the chance of being chronic LBP (R2=0.39). Including year-mean pain scale, the grades of feeling numbness, social functioning factor of SF-36 (SF-SF) and CHQ-12, these can well predict the chronic LBP with significance (p<0.1). And the ODI, CHQ-12 and P-VAS can present the QOL who has LBP (R2=0.59). We can almost confirm that the patient is only acute LBP if all of these scales remain near normal. Most patients (>80%) with LBP will not last for more than 7 days. The times of pregnant and BMI are both of the most important risk factors. The patients will more easy to have chronic LBP if you delivered the baby more than 3 times and BMI is higher than normal. Smoking is also another risk factors but there is no significant different between the chronic and acute LBP (p>0.1). Chronic LBP drink more tea or coffee than acute LBP with significant different (p<0.01). The less exercise and entertainments with chronic LBP compares with acute LBP and it is significant different (p<0.01). So it will decrease the chance of getting chronic LBP with regular exercise and proper entertainment.

This item is only available electronically.
Background: Research has identified that paediatric chronic pain reduces their quality of life. Childhood and adolescent developmental changes and parental influence throughout childhood differentiate the experience of paediatric chronic pain to adulthood chronic pain. The purpose of this study was to: (1) extend our knowledge of the effect of paediatric chronic pain on functional disability, sleep problems, emotional wellbeing and school performance; (2) assess the effect of parental mental ill-health on children and adolescents with chronic pain ; and (3) assess the effectiveness of a multidisciplinary team therapeutic intervention. Methods: South Australian Women’s and Children’s Paediatric Chronic Pain Unit patients between March 2018 and December 2019 were invited to participate. Eighty-two participated in the study. Results: Increased functional disability and sleep problems, and reduced emotional wellbeing reduced participants school performance. Parental depression mediated the associations between functional disability; sleep problems; emotional wellbeing; and school performance, whereas parental self-blame and feelings of helplessness mediated the association between sleep problems; emotional wellbeing; and school performance. Multidisciplinary team therapeutic intervention was effective in reducing functional disability and increasing emotional wellbeing. Discussion: The findings are discussed in terms of factors that will increase children and adolescent’s with chronic pain’s quality of life. Keywords: paediatric chronic pain, school performance, parental mental ill-health, multidisciplinary team intervention
Thesis (B.PsychSc(Hons)) -- University of Adelaide, School of Psychology, 2019

Chronic pain is recognized for its intra- and interpersonal stress, with greater social support being associated with better patient outcomes. Urologic Chronic Pelvic Pain Syndromes (UCPPS) are pain-associated conditions that are prevalent across genders and are strongly associated with diminished quality of life (QOL). To date, no gender-based research has examined such supportive behaviours in UCPPS samples. One model, the stress-buffering model of social support, suggests people with greater support within their proximal (e.g., marriage) and distal (e.g., physician) social environment may be protected from negative stressor impact (i.e., pain). Due to their strong associations with poorer QoL, I hypothesized catastrophizing and perceived pain control as important intrapersonal cognitive variables to also consider in such relations between pain and patient QoL. In this dissertation, I examined several research questions using two self-report studies: 1) Are there gender differences in social support for people with UCPPS?; 2) Does social support moderate the relationship between pain and patient outcome variables and are there gender differences in this effect?; and 3) If social support moderates the relationship between pain and outcomes, is this effect further moderated by cognitive variables and/or gender? In Studies 1 and 2, women with IC/PBS endorsed higher levels of solicitous and distracting spouse responses to pain behaviour than did men with CP/CPPS. Additionally, in Study 2 women reported greater support from friends than did men. In regard to moderation effects in Study 1, distracting spouse responses buffered the relationships between patient pain and mental QoL, and between pain and disability. However, spouse solicitousness had a detrimental effect on the relationship between patient pain and mental QoL but only at low levels of catastrophizing in the patient. The genders did not differ in the effect of spouse responses to pain behaviour in Study 1, and Study 1 results with respect to the stress-buffering role of distracting spouse responses were not replicated in Study 2. In Study 2, sources of social support from outside of the marriage also did not have a stress-buffering effect on the relationship between pain and patient outcome. Of the models reviewed, no one current model for understanding the role of social support or catastrophizing in chronic pain was sufficient to account for the findings reported in these studies. However, a dyadic emotion regulation perspective is suggested with implications for marital therapy with couples with chronic pain.
Thesis (Ph.D, Psychology) -- Queen's University, 2013-11-18 19:17:11.276

Vulvodynia, a common form of chronic vulvovaginal pain, is conceptualized as a multifactorial chronic pain condition. Research has examined the role of numerous physiological, psychological, and social factors in the development and maintenance of vulvodynia, however, health care experiences have not been closely examined in this clinical population. Three online studies were conducted to investigate the health care experiences of women with chronic vulvovaginal pain. Study 1 examined pelvic examination (PE) experiences in women with and without chronic pain during intercourse. During their last PE, women with pelvic and vulvovaginal pain reported significantly more pain and anxiety compared to women without pain during intercourse. Various predisposing (first PE experience), examination (quality of patient- physician interaction, physician gender), and psychological factors (vaginal penetration cognitions, body image) predicted PE ratings in women with and without pain during intercourse. Study 2 more broadly examined pain and adjustment in women with vulvovaginal pain. Pain-related beliefs (i.e., attributional style, perceived control) were related to health care variables and predicted adjustment. First, global attributions predicted depressive symptoms and pain-related cognitions/responses after controlling for pain severity and interference. Second, chance beliefs moderated the relationship between pain-related cognitions/responses and internal attributions. Third, women with higher chance and lower physician pain beliefs reported lower social support. Study 3 investigated the knowledge, attitudes, and comfort of Canadian medical residents in Family Medicine and Obstetrics and Gynecology (OBGYN) about vulvodynia. OBGYN residents later in their training reported greater knowledge and comfort with vulvodynia and its symptoms than their more junior counterparts; ratings did not significantly differ between specialties. Residents did report significantly more positive attitudes toward patients with ii vulvovaginal pain of identifiable pathology in comparison to patients with no physical findings. Comfort discussing sexuality in medical practice was a significant predictor of knowledge, attitudes, and comfort with vulvodynia after controlling for demographics/training variables. These findings offer a multidimensional perspective on the role of health care in biopsychosocial models of vulvovaginal pain, and have implications for the assessment and treatment of vulvodynia and Genito-Pelvic Pain/Penetration Disorder.
Thesis (Ph.D, Psychology) -- Queen's University, 2014-04-24 16:39:05.723

Research into the mechanisms of hyperalgesia is ongoing with the goal of improving clinical management of chronic pain. One animal model of chronic musculoskeletal pain uses two injections of acidic saline into a lateral gastrocnemius muscle to induce a long-lasting bilateral decrease in paw withdrawal thresholds. This study tested whether the two injections need to occur in the same muscle. Male Sprague-Dawley rats were injected with acidic saline (pH 4.0) in either the lateral or medial head of gastrocnemius or the contralateral gastrocnemius (lateral head). All animals received a second injection in the ipsilateral gastrocnemius (lateral head). Mechanical withdrawal thresholds were reduced in all groups when tested 24 hours after the second injection. Animals in which the first muscle injection was substituted with a non-specific treatment (intraperitoneal injection of lipopolysaccharide) developed bilateral hyperalgesia after a single acidic saline injection. Thus, the mechanism of hyperalgesia in this model is not restricted to the injected tissues and may include central nervous system structures. Consistent with this, an inhibitor of glia cell activation (minocycline) blocked the development of bilateral hyperalgesia. These data indicate that the central nervous system may play a large role in mediating chronic musculoskeletal pain.
October 2007

Low back pain (LBP) is regarded as a major health and economic problem in western industrialised countries even at this time in the twenty-first century. Researchers estimate that it has increased to affect about 45% of the population in 2011. This increase creates a major burden on the health care services, social structures and the economy in terms of absenteeism from work. CNSLBP is still poorly understood. Main reasons for the poor understanding of CNSLBP discussed in this study are the limited understanding of the effect of the spine as kinetic chain which includes the head and pelvic girdle and with its attachments to the scapulae . The process of development of ISMS dysfunction are discussed as a combination of abnormal spinal loading, soft and neural tissue plasticity that result in biomechanical malalignment, adaptive and maladaptive movement patterns, pain processing integrated with psychosocial factors that influence the biomechanical, pain processing and psychological responses are discussed as possible mechanisms in the development of CNSLBP. The researcher developed a multidimensional manual therapy model to manage patients with CNSLBP based on metacognitive reflection on her clinical reasoning over a period of 40 years as the research methodology. The metacognitive reflection has been performed within the interpretive paradigm The model that resulted from the metacognitive reflection is dialectic in nature because it entails the understanding of the patient‘s problem from an interpretive as well as from an empirico-analytical perspective. The model is conceptualised in three stages: Firstly the conceptualisation of the integrated spinal movement system (ISMS), to indicate that the spine, head, shoulder and pelvic girdles function as a closed kinematic chain. Secondly the process of the development of ISMS dysfunction as a major concept in the clinical picture of patients with CNSLBP is based on functional anatomy of the ISMS and the researcher‘s clinical observation in clinical practice. The researcher indicates how the development of ISMS dysfunction and characteristic adaptive behaviour are integrated components of the patient‘s complex heterogenic clinical picture. The underlying process for the development of ISMS dysfunction as a possible mechanism for CNSLBP is described as plasticity of soft and neural tissues (including the brain) which result in chronicity over time. Thirdly a multidimensional manual therapy model to manage patients with CNSLBP‘s heterogenic condition is discussed. The model indicates how the mechanisms underlying the development of ISMS dysfunction is addressed in a multidimensional approach to patient management. Finally the multidimensional manual therapy model is discussed in relation to other relevant intervention approaches. The model finally serves as a point of departure for planning and conducting appropriate research in basic and clinical sciences. The multidimensional manual therapy model for the management of patients with CNSLBP has been developed in clinical practice and is presented as a practicetheory in the form of a model.
Thesis (PhD)--University of Pretoria, 2013.
gm2013
Physiotherapy
Unrestricted

Chronic pain in children and adolescents is common; approximately 5% of children and adolescents report chronic pain along with moderate to high pain-related disability. Chronic pain is a subjective experience and can best be explained by a bio-psycho-social approach, which suggests reciprocal relations between different levels of this multidimensional phenomenon. The different dimensions of chronic pain need to be considered for a comprehensive assessment. Due to the subjective nature of pain, the child’s self-report is usually considered the best available and most valid estimate of the pain experience. A reliable and multidimensional assessment is an indispensable requirement for treatment planning. To date, questionnaires in German language are available to assess a wide range of relevant parameters in pediatric chronic pain. However, so far, no validated self-report tool exists to assess sensory and affective pain perception in children. These two parameters are of relevance since they describe aspects of the biological as well as the psychological dimension of chronic pain. Furthermore, a comprehensive diagnostic approach combining parameters from the three dimensions of chronic pain does not yet exist for children and adolescents. Such a comprehensive approach could be used for sample descriptions and standardized comparisons across different populations; it could serve as an approach for treatment planning or to classify outcome. This doctoral thesis is aimed at further developing the available diagnostic measures for older children and adolescents with chronic pain based on the above mentioned gaps in pediatric pain assessment. Research was performed on three patient samples. Sample 1 includes data from a prospective assessment at the German Pediatric Pain Centre from August 2008 to March 2009 (N(1)=139). Sample 2 includes retrospective data from patients who were treated at the German Pediatric Pain Centre from July 2005 to June 2010 (N(2)=1242). Sample 3 consists of pediatric pain patients who started an intensive interdisciplinary inpatient treatment between November 2009 and July 2011 (N(3)=83). In a first study, a tool to assess sensory and affective pain perception, the Pain Perception Scale for Adolescents, was adapted and validated in an adolescent clinical sample (Sample 1). The Pain Perception Scale for Adolescents allows pain patients to provide a valid and reliable self-report of parameters for both the biological and psychological dimensions of pain. In a second study, this tool was applied to a further sample of adolescents with migraine and tension-type headache (subsample of Sample 2). It was demonstrated that, contrary to the official headache classification guidelines, the sensory pain perception in this sample did not differentiate between migraine and tension-type headache. To develop a multidimensional assessment approach, in a third study, an adult classification system (Chronic Pain Grading) was applied to a sample of pediatric pain patients (Sample 2). This approach proved useful as a valid measure for a brief operationalization of pain problem severity, including pain intensity and pain-related disability only, and as an outcome measure. However, it displayed major shortcomings with regards to treatment stratification. To further develop an approach for treatment stratification and treatment planning, a fourth study focused on developing a new multidimensional approach for subgroup classification (subsample of Sample 2). The stability of subgroups was demonstrated in a cross-validation with an independent sample (Sample 1). Furthermore, the identified subgroups displayed distinct treatment outcomes after a standardized treatment program (Sample 3). In conclusion, this doctoral thesis offers an addition to diagnostic measures for older children and adolescents with chronic pain by adding the Pain Perception Scale for Adolescents and by proving the validity of the Chronic Pain Grading for the application in this patient group. These tools allow a valid description of adolescents’ subjective pain experience. Results from this doctoral thesis also indicate that the findings from adults cannot be readily transferred to children and adolescents. The final output of this doctoral thesis is a bio-psycho-social classification approach that identifies subgroups of adolescents with chronic pain with treatment relevant differences. This is a first step toward the development of subgroup-specific treatment.

With chronic post surgical pain affecting up to one third of patients undergoing surgeries and the price of treatment being astoundingly high there has been a transition in research to investigate and identify risk factors. Through identification of risk factors new preventative measures can be taken to ensure better surgical outcomes. The role that psychosocial factors can play in the development of chronic post surgical pain has long been recognized yet its mechanisms are still unknown. We aim to investigate how environment can play a direct role in pain perception and sensitivity. We used a Chronic Mild Stress (CMS) paradigm to induce depression in 10 adult male mice, we used 10 control mice who were left in standard opti cages, and 10 enriched mice who were placed in large enrichment cages. CMS mice were exposed to a series of stressors and all mice underwent spared nerve injury surgery. During spared nerve injury the common peroneal and tibial branches of the sciatic nerve were severed while the sural branch was left intact. Overall well-being and pain threshold of mice were tested via Von Frey, Hot Plate, Heat Place Preference, Dynamic Weight Bearing, Hole Board, and Social Interaction. It was found that CMS mice experienced thermal hyperalgesia yet normal thermal threshold sensation. CMS mice also spent less time interacting with novel mice in social interaction, and less amount of time exploring the center of the hole board arena than control or enriched mice. While Von Frey results did not change over the course of the experiment, dynamic weight bearing results indicated spared nerve injury surgery was successful and produced chronic pain. Results indicate that environment plays a role in thermal pain perception and CMS affected overall well being of mice as CMS mice exhibited more timid and anxious behavior.

Due to the subjective nature of pain and the profound debilitating effects of pain for a growing number of people, there are many challenges to approaching and fully addressing its problems. The traditional biomedical model of health limits its treatment focus to the physical components of pain. Biomedicine provides useful and effective short-term relief of bodily symptoms, but usually cannot cure pain that persists in both mind and body over time. Because chronic pain is often accompanied with discomfort, depression, and other significant life impairments, health researchers have recently conceptualized more comprehensive models to address pain. In the bio-psycho-social-spiritual health model, chronic pain is assessed and treated in the context of a person’s overall quality of life, considering biological, psychological, social, and spiritual health conditions. This movement towards adopting integrative health care models can also provide patient guidance needed for developing inner resources to adapt to pain, as well as recover from and prevent disease. Self-compassion comes from a fertile field of inquiry emerging out of a wider conception of health that includes spirituality. The construct is based on three related components that can assist a person living with pain: (a) being kind to oneself while in pain or suffering, (b) perceiving difficult times as shared human experiences, and (c) holding painful thoughts and feelings with mindfulness, instead of over-identification. Measured using the Self-Compassion Scale, it demonstrates positive associations with a variety of health indicators. However, a direct relationship with chronic pain has not yet been examined. In applying recent research in quality of life (QoL) and self-compassion to a chronic pain patient population, the purpose of this study is twofold: (a) to produce a comprehensive assessment of bio-psycho-social-spiritual QoL conditions (b) to examine differences in QoL with the presence of self-compassion and determine its potential moderating effect on life impairments due to pain. From this project, the QoL conditions that are affected by chronic pain and the moderation effect of self-compassion will be understood better so that more effective treatment and prevention procedures can be developed for people living with pain from long-term disease conditions.
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