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1
Bustamante, Mirayo Antonio. "Pain Diary : Pain Management Platform". Thesis, Uppsala universitet, Institutionen för informationsteknologi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-177259.
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In the context of current human diseases and conditions, chronic pain is among the most typical reasons for seeking medical attention and is seen in 20 to 50 percent of patients attending primary care (Bajwa Z. H., 2012). With those figures in hand, the medical specialty of pain is of increasing interest to the scientific community and other parties involved in the management of chronic diseases. In the practical sense, chronic pain patients usually have, as of now, regular check-up appointments with their pain specialist, where medication is modified or maintained depending on the frequency and intensity of the patient’s pain episodes. As a matter of fact, between appointments, patients are usually encouraged to write a comprehensive account of their pain episodes and their characteristics in the form of a pain diary. In such diary, they write the intensity of their pain in a relative scale from 1 to 10, the location of the pain in their body, and other relevant comments, namely medication side-effects or the activity they were performing when pain appeared. This set of data is then used by pain specialists to calibrate the patient’s medication and follow their treatment. Pain Diary, the project developed and described in the present document, seeks a more flexible, precise approach for patients to record their pain diaries. The project emphasizes on the interaction between the patient and an electronic pain diary, in the form of an application for the iOS platform. This document discusses the human-computer interaction analysis, usability tests, accessibility tests, and prototypes created to develop a comprehensive user-oriented solution for patients of cancer and other chronic diseases. Finally, the paper will present a functional prototype created for iOS, taking into account UX (user experience) design and interaction, as well as a RESTful back-end to consider in a future large scale implementation of the project.
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Peters, Madelon Louise. "Chronic pain and pain perception". Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Maastricht University [Host], 1992. http://arno.unimaas.nl/show.cgi?fid=8259.
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Jylli, Leena. "Acute pain in pediatric patients : aspects of pain management and pain assessment /". Stockholm, 2004. http://diss.kib.ki.se/2004/91-7140-135-0/.
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Blackburn, Alison. "Living with pain or living in pain : narrative journeys with low back pain". Thesis, Northumbria University, 2011. http://nrl.northumbria.ac.uk/1536/.
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This study used a qualitative method to focus on the perspectives, beliefs and expectations of low back pain sufferers. The research was undertaken within a hospital based pain clinic. In recent years low back pain research has proliferated, and the epidemiological evidence suggests that back pain is an increasing problem. Much attention has been paid to the impact of low back pain on the population, and to the increasing cost in economic and health terms. Biomedical and psychological evidence abounds to shape acute and chronic management of low back pain, but there is a dearth of information about the viewpoint of those suffering pain. This study attempted to bring the understanding of the back pain sufferer to the fore. Issues of quality of life, functional ability and the impact of back pain on their lifestyle were explored, along with the influence of contextual factors in relation to how back pain sufferers perceived themselves and how others perceived them. A narrative method was utilized to illuminate the journey with pain. Nine interviews were conducted, and the interpretation and presentation of the narratives generated was influenced by Ricoeur’s interpretative theory. Thematic analysis revealed that doctorability, agency, control, separation or acceptance of the pain and the concept of future life were key features within the narratives. The analysis highlighted that for the majority in this study pain arrived uninvited following a traumatic accident or incident, and back pain became a chronic condition. It was always unwanted and initially it was unexpected as the usual script for pain is one of a transient incapacity followed by recovery. It was precisely this deviation from the norm that resulted in difficulties for the people suffering the pain. Biographical differences did not appear to be identifiable in the themes discerned in the stories, nor in the overall structure.
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Jansaithong, Jarassri. "Northern Thai school-aged children pain experience : pain descriptions and pain management strategies /". Thesis, Connect to this title online; UW restricted, 2002. http://hdl.handle.net/1773/7184.
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Manduch, Marosh. "Stimulation-evoked pain and temperature sensations in thalamus of pain and non-pain patients". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape7/PQDD_0006/MQ46163.pdf.
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Frost, Michael. "Is pain still an issue in pain management?" Thesis, Bangor University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.483541.
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Grant, Nancy Anne Tully. "Pain measurement : validation of the Sensory Pain Questionnaire". Thesis, McGill University, 1987. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=63861.
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Boichat, Charlotte Sarah. "Anxiety-related pain constructs, attentional bias and pain". Thesis, University of Bath, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.539551.
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Osborn, Jody. "Pain generated by observation of others in pain". Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/1753/.
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Recently, observation of pain has been linked to areas of the brain coding the sensory/discriminative aspects of pain (Avenanti et al., 2005; Avenanti et al., 2006). The experiential qualities associated with observing another in pain are poorly understood. In this thesis, we demonstrate that pain generated by observation of others in pain is reported by a significant minority of healthy individuals. The pain reported is mild, transient and occurs in the same location as the observed pain. Ten pain responders were matched with ten non-responders to take part in an fMRI study observing others in pain. Responders activated emotional and sensory brain regions associated with pain while the non-responders activated very little. Reports of pain were more likely to be accompanied by a pain memory. Pain responders are quicker to represent the perspective of others and have a more flexible sense of body ownership but are not more likely to report somatic symptoms during incongruent sensori-motor feedback. These findings provide convincing evidence that some people can readily experience pain during observation of others‘ pain. It is plausible that the mechanism underpinning pain reports evoked by observation of pain is not specific to pain processing per se.
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Mills, Emily. "Pain-modulation neural circuits underlying chronic orofacial pain". Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/21813.
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We have all experienced short-term pain that results from a brief noxious (harmful) stimulus. When we encounter noxious stimuli, the intensity of our pain response is modulated through the activation of pain-modulation neural circuits in the brain. Specifically, systems within the brainstem can both inhibit and facilitate nociceptive (i.e. pain-related) information when it first enters the central nervous system, either in the spinal cord dorsal horn or in the spinal trigeminal nucleus (SpV) in the brainstem for information relating to orofacial (face and mouth) regions. Pain-modulation systems serve a clear biological purpose – in some situations, pain inhibition is highly beneficial as it allows us to focus on escape or defensive behaviours; in other circumstances, pain facilitation can be helpful as it encourages us to rest and recover from potential tissue damage. Despite many of us experiencing short-term pain that is associated with an injury, for reasons that are unclear, some individuals experience long-lasting chronic pain that persists for months or years after the initial injury has healed. There is growing evidence from experimental animal investigations to suggest that the functioning of the pain-modulation circuits, particularly those centred around the rostral ventromedial medulla (RVM) and locus coeruleus in the brainstem, is compromised in chronic pain conditions. These preclinical studies suggest that both neuropathic pain (i.e. pain related to somatosensory nervous system damage) and non-neuropathic pain (i.e. pain related to non-nervous tissue injury) are associated with a functional shift in the pain-modulation system such that it favours an overall facilitation of pain processing. This may contribute to the maintenance of long-term pain in some individuals even after the initial injury has resolved. In humans, there is emerging evidence from psychophysical studies to suggest that some chronic pain conditions, including orofacial conditions, are associated with altered pain-modulation capacities. However, to date, pain-modulation circuit functioning has not been directly explored in individuals with chronic pain. The overall aim of this thesis was to use resting-state functional magnetic resonance imaging (fMRI) to explore the ongoing function of brainstem pain-modulation neural circuits in humans with chronic neuropathic and non-neuropathic orofacial pain. The first investigation (Chapter 2) aimed to determine whether a neuropathic pain condition, painful trigeminal neuropathy (PTN), is associated with altered ongoing functioning in RVM and locus coeruleus pain-modulation pathways. We performed functional connectivity analyses to investigate whether there is an altered coupling of fMRI signals between the RVM, locus coeruleus and other pain-modulation regions in PTN patients compared with pain-free controls. We identified that individuals with PTN display enhanced functional connectivity (signal coupling) between the RVM and other pain-modulation sites, including the midbrain periaqueductal gray (PAG), locus coeruleus and subnucleus reticularis dorsalis (SRD). Additionally, we found that PTN patients display enhanced RVM functional connectivity with the SpV, the region that first receives nociceptive information from orofacial regions. Together, these results show that PTN is associated with functional alterations within the brainstem pain-modulation network and the SpV. Considering the existing experimental animal literature, it is likely that this represents an ongoing and enhanced engagement of brainstem pain-facilitating processes that may contribute to persistent pain in individuals with neuropathic pain conditions. The second investigation (Chapter 3) aimed to explore whether painful temporomandibular disorder (TMD), a non-neuropathic pain condition characterised by pain around the temporomandibular joint, is also associated with alterations in signal coupling between the RVM and other brainstem pain-modulation regions. In this investigation, we employed two functional connectivity techniques to explore the coupling of fMRI signals averaged over the entire scan (“static” functional connectivity) in addition to changes in signal coupling over the course of the scan (“dynamic” functional connectivity) to explore pain-modulation circuit function in TMD patients compared with pain-free controls. We identified that, compared to controls, TMD patients display enhanced RVM static and dynamic connectivity with the SpV and SRD, and no change in RVM connections with the PAG and locus coeruleus. These findings show that TMD is associated with functional alterations within specific brainstem pain-modulation circuits that regulate nociceptive processing at the SpV. Consistent with the findings from preclinical studies, and similar to neuropathic conditions, these ongoing functional changes in TMD likely reflect an enhanced descending facilitation of nociceptive processing at the SpV that contributes to the maintenance of pain in these individuals. The first two investigations (Chapters 2 and 3) revealed that individuals with both neuropathic and non-neuropathic pain display functional alterations within pain-modulation circuits that likely contribute to the presence of ongoing pain. In addition to persistent pain, many patients with neuropathic pain report spontaneous fluctuations in their pain intensity. It is possible that moment-to-moment variations in pain-modulation system functioning can contribute to these spontaneous fluctuations in chronic pain intensity. As such, the third investigation (Chapter 4) aimed to determine whether, within PTN individuals, there are differences in RVM functional connectivity strengths with other brainstem regions during scan periods in which patients experience high versus low pain. We found that PTN patients displayed stronger RVM connectivity strengths with both the PAG and SpV during the period of highest compared with lowest reported pain. These findings show that moment-to-moment fluctuations in spontaneous neuropathic pain intensity are associated with functional changes in the pain-modulation system. Given that this system can both facilitate and inhibit nociception, these findings may reflect short-term variations in descending pain-modulation output at the SpV that contribute to short-term changes in spontaneous pain intensity. Overall, this series of investigations reveals that both neuropathic and non-neuropathic orofacial pain conditions are associated with ongoing functional changes in the brainstem pain-modulation circuits. Additionally, in neuropathic pain, short-term variations in brainstem system functioning are associated with spontaneous fluctuations in ongoing pain intensity. Together, these findings suggest that functional alterations within the pain-modulation neural circuits are associated with the presence and intensity of ongoing chronic orofacial pain in humans. Considering these data alongside the existing experimental animal research, it is likely that, following injury, some individuals experience a change in pain-modulation circuit functioning such that it favours the facilitation of nociceptive processing. This may contribute to the maintenance and intensity of persistent orofacial pain in some individuals following injury.
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Miller, Andrew. "Ingenious pain". Thesis, Lancaster University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337550.
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Hanson-Parkes, Jannae. "Chronic pain". Online version, 2002. http://www.uwstout.edu/lib/thesis/2002/2002hansonparkesj.pdf.
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Almeida, Marina Barbosa de. "Imagining pain". reponame:Repositório Institucional da UFSC, 2012. http://repositorio.ufsc.br/xmlui/handle/123456789/94772.
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Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Comunicação e Expressão, Programa de Pós-Graduação em Letras/Inglês e Literatura Correspondente, Florianópolis, 2011Made available in DSpace on 2012-10-25T15:51:07Z (GMT). No. of bitstreams: 1 297994.pdf: 2120603 bytes, checksum: f399d37e8a1be779e659cfa014006b86 (MD5)
A presente tese reflete sobre maneiras de sermos afetados por representações de violência e sofrimento humano. A discussão parte da incapacidade do discurso midiático em sensibilizar sua audiência quando imagens violentas não são capazes de causar choque e empatia. Em contraste a estas representações, este estudo examina representações literárias e a experiência de leitura de narrativas que são temática e esteticamente violentas. O argumento segue a metodologia proposta por Marco Abel (2007) na qual a representação de eventos violentos é abordada em termos de sua força estética; em termos do potencial da literatura em suspender o significado e a verdade evitando, assim, a transformação da experiência da violência em uma representação da violência. As análises de Beloved (1987) de Toni Morrison, Push (1996) de Sapphire e The Dew Breaker (2004) de Edwidge Danticat ilustram como escritoras negras norte-americanas utilizam o recurso narrativo deferral of truth ("postergar a verdade"). Tal recurso carrega o potencial de subverter o conhecimento do leitor, trazer de volta sensação e oferecer a possibilidade de criarmos novos significados. Desta forma, estas narrativas de violência e dor tornam-se espaços de indeterminação e dúvida, mas também de imaginação, criatividade e reflexão.
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Wartolowska, Karolina. "Understanding patn processing in chronic pain patients using neuroimaging tools". Thesis, University of Oxford, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.526128.
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Crothers, Elizabeth Anne. "Labour pains : a study of pain control mechanisms during labour". Thesis, University of Ulster, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.260346.
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Sorrell, John T. "Effects of pain and fear stimulus intensity levels on pain responding in chronic pain patients". Morgantown, W. Va. : [West Virginia University Libraries], 2000. http://etd.wvu.edu/templates/showETD.cfm?recnum=1712.
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Thesis (M.A.)--West Virginia University, 2000.Title from document title page. Document formatted into pages; contains viii, 61 p. : ill. Includes abstract. Includes bibliographical references (p. 23-27).
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Anderson, Ruth. "Dancing in pain : pain appraisal and coping in dancers /". [St. Lucia, Qld.], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18372.pdf.
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Norberg, Anna. "Genetics of pain : studies of migraine and pain insensitivity". Doctoral thesis, Umeå : Medical Biosciences Medicinsk biovetenskap, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-776.
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Gradin, Maria. "Procedural pain reducing methods and pain assessment in newborns /". Linköping : Univ, 2004. http://www.bibl.liu.se/liupubl/disp/disp2004/med868s.pdf.
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Nguyen, The Tung. "Un environnement pour le calcul intensif pain à pain". Phd thesis, Institut National Polytechnique de Toulouse - INPT, 2011. http://tel.archives-ouvertes.fr/tel-00657952.
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Le concept de pair à pair (P2P) a connu récemment de grands développements dans les domaines du partage de fichiers, du streaming vidéo et des bases de données distribuées. Le développement du concept de parallélisme dans les architectures de microprocesseurs et les avancées en matière de réseaux à haut débit permettent d'envisager de nouvelles applications telles que le calcul intensif distribué. Cependant, la mise en oeuvre de ce nouveau type d'application sur des réseaux P2P pose de nombreux défis comme l'hétérogénéité des machines, le passage à l'échelle et la robustesse. Par ailleurs, les protocoles de transport existants comme TCP et UDP ne sont pas bien adaptés à ce nouveau type d'application. Ce mémoire de thèse a pour objectif de présenter un environnement décentralisé pour la mise en oeuvre de calculs intensifs sur des réseaux pair à pair. Nous nous intéressons à des applications dans les domaines de la simulation numérique et de l'optimisation qui font appel à des modèles de type parallélisme de tâches et qui sont résolues au moyen d'algorithmes itératifs distribués or parallèles. Contrairement aux solutions existantes, notre environnement permet des communications directes et fréquentes entre les pairs. L'environnement est conçu à partir d'un protocole de communication auto-adaptatif qui peut se reconfigurer en adoptant le mode de communication le plus approprié entre les pairs en fonction de choix algorithmiques relevant de la couche application ou d'éléments de contexte comme la topologie au niveau de la couche réseau. Nous présentons et analysons des résultats expérimentaux obtenus sur diverses plateformes comme GRID'5000 et PlanetLab pour le problème de l'obstacle et des problèmes non linéaires de flots dans les réseaux.
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Armstrong, Mary P. "Chronic low back pain : effectiveness of pain management programmes". Thesis, University of Ulster, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273038.
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BRANDAO, MONICA CRISTINA DE CARVALHO CAMPIOLI. "SYSTEMIC LUPUS ERYTHEMATOSUS: PHYSICAL PAIN,PAIN OF THE SELF". PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2003. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=4093@1.
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COORDENAÇÃO DE APERFEIÇOAMENTO DO PESSOAL DE ENSINO SUPERIORFocalizando o Lúpus Eritematoso Sistêmico como uma doença psicossomática, localizada no limiar entre o psíquico e o físico, esta dissertação pretende contribuir para o estudo do trauma, da dor psíquica e física, utilizando-se das teorias de Winnicott e Freud para este fim. Considerando que a dor física faz parte do quadro clínico do Lúpus Eritematoso Sistêmico, este trabalho levanta a questão de que o quadro álgico torna-se muitas vezes insuportável, por se somar à dor física, o eu que dói, decorrente de traumas vividos. O corpo adoecido e dolorido reclama a ausência de um meio ambiente bom o bastante levando a quebra na vivência de continuidade do ser, (Winnicott), assim como a ausência de uma barreira de estímulos (Freud) forte, que permita o desenvolvimento adequado do eu. Para ilustrar as idéias apresentadas no trabalho, foram retirados fragmentos dos relatos, realizados no ambulatório do Hospital Universitário Pedro Ernesto.
Focusing Systemic Erythematosus as a psychosomatic disease, located in the difficult thesrhold between the psychic and the physical, this dissertation intends to contribute for the study of the trauma, of psychic and physical pain, using the theories of Winnicott and Freud for this purpose. Considering that physical pain is part of the clinical picture of Systemic Lupus Erythematosus, this work raises the subject that of pain becomes many times unbearable, considering that to physical pain, pain of the self is odded, due to past, experienced traumas. The sick and aching body claims the break in the experience of the continuity of being, lock of a good enough environment (Winnicott), as well as lock of a strong stimuli barrier (Freud), allowing for on appropriate development of the self. To illustrate the ideas presented in this work, fragments of patients reports from the clinic of the University Hospital, Pedro Ernesto, were used for this purpose.
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Becker, Bettina. "Narratives of pain in old age : challenging 'ordinary' pain". Thesis, University of Winchester, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.311849.
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This thesis is based on narrative interviews with older people who live with pain and explores the meanings they develop. From their stories it emerged that constructions of ageing shape the meaning of pain. Pain is consequently constructed as `ordinary', non-disruptive pain that is a natural consequence of ageing. However, the narrators also developed alternative meanings. They constructed their pain as unique and disruptive, contested age-based definitions of their pain, and resisted medical intervention. The thesis explores the conflicts and contradictions that arise out of these multiple constructions.
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Muir, R. "Living with chronic pain following a pain management programme". Thesis, University of Liverpool, 2014. http://livrepository.liverpool.ac.uk/2008410/.
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Chronic pain is pain that has lasted for longer than six months (B.H. Smith, Elliott, & Hannaford, 2004) and has a wide ranging impact on individuals’ lives, affecting physical, social and psychological functioning (B. H. Smith et al., 2001). Despite the impact of chronic pain and the significantly increased use of healthcare (Von Korff, Wagner, Dworkin, & Saunders, 1991), the effectiveness of treatments for chronic pain are limited to a minority of individuals, whether of a medical or psychological orientation (Turk, 2005). One approach to chronic pain is through pain management programmes, which aim to increase individuals’ quality of life, psychological functioning and levels of activity (British Pain Society, 2007). Although previous reviews of the effectiveness of pain management programmes have concluded that such programmes are effective (Eccleston, Williams, & Morley, 2012; Flor, Fydrich, & Turk, 1992; Scascighini, Toma, Dober-Spielmann, & Sprott, 2008), these reviews have focussed on the short-term (less than 12 months) outcomes. Considering that such programmes do not ameliorate pain and that individuals will often experience pain for the rest of their lives there is a need for review of the long-term outcomes of these programmes. Paper one of this thesis is a review of the quantitative literature concerning long-term (greater than 12 months) psychological and quality of life outcomes of pain management programmes. Whilst quantitative research concerning chronic pain has focussed upon the shortterm effectiveness of psychological treatments, qualitative research has focused upon the experience of chronic pain prior to interventions (Hellström, 2001; J. A. Smith & Osborn, 2007; Toye et al., 2013). In particular, this research has highlighted themes relating to a changing understanding of individuals’ bodies and a threat to their identity (Hellström, 2001; Osborn & Smith, 2006; J. A. Smith & Osborn, 2007; Toye et al., 2013). As there is now greater certainty of the effectiveness of psychological approaches to chronic pain (Eccleston, Williams, & Morley, 2012) there is currently a shift away from studies of the effectiveness of interventions to a greater focus upon the mechanisms of change (McCracken & Marin, 2014; Morley, Williams, & Eccleston, 2013). Qualitative research of living with chronic pain following pain management programmes would inform both clinicians’ and researchers’ understanding of the experience of living with chronic pain after an intervention and therefore contribute to the development of this area of research. It would also help to contextualise psychological models of chronic pain (Hayes, Strosahl, & Wilson, 2004; Vlaeyen & Linton, 2000) within a phenomenological understanding (J. A. Smith, Flowers, & Larkin, 2009). The second paper of this thesis aims to provide a phenomenological account of the experiences of participants who have completed a pain management programme 12-36 months prior to participating in the research.
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Galli, Ursula. "Stress and pain (dys)regulation in chronic orofacial pain". Göttingen Cuvillier, 2008. http://d-nb.info/99103158X/04.
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Kappesser, Judith. "Pain judgements in other people investigating underestimation of pain /". [S.l. : s.n.], 2005. http://www.bsz-bw.de/cgi-bin/xvms.cgi?SWB11759435.
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Vo, Lechi. "Understanding pain: How is pain processed in healthy humans?" Thesis, Vo, Lechi ORCID: 0000-0002-2714-5387 (2014) Understanding pain: How is pain processed in healthy humans? PhD thesis, Murdoch University, 2014. https://researchrepository.murdoch.edu.au/id/eprint/21909/.
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The aim of this thesis was to examine the effects of experimentally-induced limb pain on pain in other remote body sites in a pain-free healthy population. In Study one, we compared the effects of limb-pain induced by high-frequency electrical stimulation (HFS) and ultraviolet B (UVB) on sensitivity to heat, and to sharpness and pressure-pain on the conditioned forearm site, the contralateral control site, and on each side of the forehead in samples of 30 (HFS) and 16 (UVB) healthy participants. Prior to pain induction, sensitivity to heat, sharpness and pressure-pain was similar at the conditioned site and the control site, and between the two sides of the forehead. UVB triggered more intense signs of primary hyperalgesia at the conditioned site than HFS. Secondary hyperalgesia developed after HFS but not UVB, indicating that HFS evoked signs of central sensitisation. Pressure-pain sensitivity decreased on both sides of the forehead with a greater reduction on the ipsilateral side after HFS, but not UVB. Furthermore, electrically-evoked pain at the HFS-conditioned site decreased significantly more during ipsilateral temple cooling than contralateral cooling, whereas pain reduction at the UVB-conditioned site was similar irrespective of the side of forehead that was cooled. Thus, central sensitisation evoked by HFS might also have triggered ipsilateral pain-inhibitory modulation processes in healthy humans.
In Study two, to further delineate pain modulation processes evoked by HFS, we examined sensory changes in the forearm and forehead, and nociceptive blink reflexes elicited by supraorbital electrical stimulation with and without counter-irritation (electrically-evoked pain at the HFS-conditioned site) in 20 healthy participants before and after HFS conditioning. In line with Study one, secondary hyperalgesia and bilateral and ipsilateral forehead analgesia to pressure-pain developed after HFS conditioning. In general, counter-irritation of the forearm and HFS suppressed pain perception, and inhibited the amplitude of nociceptive blink reflex to supraorbital stimuli. However, in the absence of forearm counter-irritation, HFS facilitated the ipsilateral blink reflex amplitude to supraorbital stimuli delivered ipsilateral to the HFS-conditioned site. Thus, HFS might have triggered hemilateral pain-inhibitory and pain-facilitatory mechanisms simultaneously.
In Study three [53], to determine whether central sensitisation is necessary for triggering this sign of ipsilateral inhibitory pain modulation, we compared the effects of HFS and low frequency electrical stimulation (LFS) in the forearm on sensitivity to pressure-pain in the ipsilateral forehead in samples of 50 (HFS) and 18 (LFS) healthy individuals. LFS was chosen as it triggers only minor sign of central sensitisation. Before conditioning, sensitivity to heat, sharpness, and pressure-pain were similar at the conditioned and the control sites, and between the two sides of the forehead. Pain perception was higher after HFS than LFS, and central sensitisation developed after HFS but not LFS. Nevertheless, pressure-pain sensitivity decreased in the ipsilateral forehead after both forms of electrical stimulation. This decrease was associated with a heightened sensitivity to pressure-pain at the conditioned forearm site, but with a reduced sensitivity to heat in skin surrounding the electrically-conditioned site. Thus, the ipsilateral pain-inhibitory process might have suppressed sensitivity to pressure-pain in the ipsilateral forehead and secondary hyperalgesia to heat.
Evidence from rat studies indicates adrenergic influences descending from the locus coeruleus (LC) in mediating ipsilateral inhibitory pain control via the activation of inhibitory α2-adrenoreceptors.Therefore, in the final study (Study four), to determine whether ipsilateral forehead analgesia to HFS is mediated by α2-adrenoreceptors, we attempted to block their effects with oral administration of yohimbine, an α2-adrenoreceptor antagonist, in a double-blind placebo-controlled crossover design in a sample of 22 healthy individuals. Sensitivity to heat, sharpness, and pressure-pain at and adjacent to the conditioned and control sites, and on each side of the forehead was assessed at baseline, following drug administration, and after HFS conditioning. Blood pressure, heart rate and electrodermal activity were also measured across these three stages. Nociceptive blink reflexes to supraorbital stimulation were also investigated following drug administration and after HFS conditioning. In addition, the effects of ipsilateral versus contralateral temple cooling on electrically-evoked pain at the HFS-conditioned site were compared. Prior to drug administration, sensitivity to heat, sharpness, and pressure-pain were similar at the conditioned and the control site, and between the two sides of the forehead. In line with our previous studies, in the placebo condition, HFS evoked primary and secondary hyperalgesia in the forearm, ipsilateral forehead analgesia to pressure-pain, and a reduction of electrically-evoked forearm pain during ipsilateral temple cooling. As expected, yohimbine increased blood pressure and electrodermal activity compared to placebo. Yohimbine also enhanced the excitability of the ipsilateral nociceptive blink reflex compared with placebo, consistent with yohimbine facilitating pro-nociceptive effects. Unexpectedly, the development of ipsilateral forehead analgesia to pressure-pain following yohimbine, and a greater reduction of electrically-evoked forearm pain during ipsilateral temple cooling following yohimbine compared to placebo, suggests that yohimbine might have enhanced analgesia. Thus, non-noradrenergic mechanisms may also be involved in mediating these analgesic effects, in addition to adrenergic influences.
Together, these findings indicate that in healthy humans noxious stimulation with HFS may trigger ipsilateral inhibitory modulation processes, which could be mediated both by noradrenergic and non-adrenergic mechanisms. Further investigation of ipsilateral inhibitory modulation processes is important, as this process may be disrupted in conditions such as complex regional pain syndrome.
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Kingsbury, Rachell. "Social pain theory : physical pain as a mediator of the relationship between social pain and defensiveness /". [St. Lucia, Qld.], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17731.pdf.
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Warbrick, Tracy. "The effects of pain related anxiety on EEG correlates of pain perception and subjective pain responses". Thesis, Staffordshire University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.438084.
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Da, Costa Kathryn T. "The pain relief paradox : an investigation of the discrepancy between retrospective pain relief and pain intensity". Thesis, University of Hull, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.252609.
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Kelly, Sioban Colette. "Structural and functional MRI studies of pain behaviour, selective attention and fear of pain in pain-free volunteers and chronic low back pain patients". Thesis, University of Liverpool, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.569583.
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The aim of the original work presented in this thesis was to investigate morphological and functional differences in clinical and control populations, which may negatively impact the experience of pain. Firstly, morphological differences were investigated between groups of healthy controls and chronic low back pain (CLBP) patients. Included in the latter were subgroups of patients not previously investigated in the current morphological literature, those with and without pain behaviour. We investigated differences in gray matter (GM) volume between groups using an automated whole brain technique, and a manual method applied to two regions of interest, namely prefrontal cortex and insular cortex. A deficit in GM volume of right dorsal prefrontal cortex between CLBP patients and controls was found, with a further deficit in left insular cortex for CLBP patients with concomitant pain behaviour. Secondly, we conducted two studies using functional magnetic resonance imaging (fMRI) and a task of selective attention. Our initial investigation provided a proof of principle regarding the suitability of a semantic dot probe task within the fMRI environment. Pain-free participants were grouped based upon fear of pain scores. The results indicated differential behavioural and functional results between the groups. The thesis culminates with an fMRl study investigating selective attention in CLBP patients with pain behaviour. The clinical group were tested prior to and on completion of an intensive multidisciplinary pain management programme (PMP), with the aim of assessing if selective attention is sensitive to cognitive interventions. Selective attentional bias was demonstrated in the clinical group for pain-related trials at both testing sessions, although the direction of attention differed. Similarly, fMRI results showed differences in neural correlates for task performance between groups, with pre-PMP results demonstrating a reliance on semantic and memory processes. The fmdings suggest that fear of pain may be a vulnerability factor in the transition from acute to chronic pain and furthermore, CLBP patients with pain behaviour have structural, functional and behavioural differences which may negatively impact their ability to cope with their pain condition.
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Mechlin, Beth Girdler Susan S. "African Americans show alterations in endogenous pain regulatory mechanisms and reduced pain tolerance to experimental pain procedures". Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2006. http://dc.lib.unc.edu/u?/etd,679.
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Thesis (M.A.)--University of North Carolina at Chapel Hill, 2006.Title from electronic title page (viewed Oct. 10, 2007). "... in partial fulfillment of the requirements for the degree of Master of Arts in the Department of Psychology (Biological Psychology)." Discipline: Psychology; Department/School: Psychology.
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Gosden, Thomas. "Images of pain : exploration of the characteristics and functions of pain-related mental imagery in chronic pain". Thesis, University of Edinburgh, 2008. http://hdl.handle.net/1842/2742.
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Introduction A recent study by Potter et al. (in submission) reported that many chronic pain sufferers experience a spontaneous mental image of their pain, and that these individuals also report higher levels of anxiety and depression. However, little is known about the nature of pain-related mental imagery or the role it might have in chronic pain problems. Research Aims This project aimed to replicate these findings with a larger sample, and to discover more about the characteristics of pain-related mental imagery. It also aimed to explore the possible function of mental imagery in inducing physiological arousal and negative emotional reactivity. Methodology The research consisted of two discrete studies. In the first study, questionnaire measures of mental imagery, pain self-report, depression, anxiety, and use of imagery in everyday life were obtained from a naturalistic sample of chronic pain sufferers (N=105). The second study interviewed fourteen participants who reported experiencing pain-related mental imagery. These participants were also asked to intentionally generate their image and subjective measures of physiological and emotional reactivity were recorded. Results A significant proportion (40%) of participants reported experiencing pain-related mental imagery. Those who did also reported significantly higher levels of depression, though a trend towards higher levels of anxiety was not statistically significant. Mental images were predominately reported to be distressing, to occur frequently (at least every day), to interfere with daily living, to be longstanding (on average of three years duration), and to be largely stable over time. The majority of participants who were asked to intentionally self-generate their image during interview reported increases in physiological arousal and negative emotional reactivity. Discussion Experiencing a mental image of pain is a common phenomenon among chronic pain sufferers. Furthermore, the images experienced are long-standing, stable, and appear to be linked with physiological and negative emotional reactivity. It therefore seems possible that these images have a role in psychological adjustment to chronic pain for some sufferers and may contribute to long-term distress and disability. These findings suggest that a greater understanding of pain-related mental imagery may contribute to the psychological assessment and treatment of chronic pain sufferers.
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Schweinhardt, Petra. "Neural correlates of clinical pain processing in neuropathic and inflammatory pain patients and comparison with experimental pain". Thesis, University of Oxford, 2006. http://ora.ox.ac.uk/objects/uuid:12e71d31-24f8-47e8-ba83-129575007644.
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The goal of this thesis was to examine the processing of clinical pain in two patient groups with well defined primary pathologies, i.e. neuropathic pain patients and patients with rheumatoid arthritis (RA). It was hypothesized that chronic pain is associated with plastic changes in pain processing brain structures that can be detected using functional magnetic resonance imaging (FMRI). The first study, presented in Chapter 3, demonstrates that the neural representation of experimental heat pain is different in neuropathic pain patients than in age- and gender-matched healthy control subjects, although the pain stimulus was applied outside clinically affected areas. Increased activation was found in amygdala and anterior insula in the patient group and was accompanied by increased state anxiety and depression scores. Anterior insula is the focus of Chapter 4 in which it is demonstrated that clinical pain processing is located significantly more anteriorly in the insula than experimental pain processing, in close proximity to neural correlates of highly negative emotions and the conscious perception of bodily sensations. This offers a potential explanation for the shift of clinical pain processing. In Chapter 5, clinical pain is contrasted with experimental pain in the same patient population, i.e. patients with RA. In addition to comparing clinical and experimental pain processing, it was investigated if emotional and cognitive determinates of the pain experience, specifically depression and catastrophizing, exert different influences on the two types of pain. It is shown that clinical pain, but not experimental pain, is likely to be driven partially by depressive symptoms whereas catastrophizing is associated with the same neural activation pattern in both conditions. The cerebral representation of allodynic pain in neuropathic pain patients is presented Chapter 6. Chapters 6 and 7 demonstrate that the FMRI signal encodes the perceived intensity of clinical allodynic pain across subjects and that it reflects longitudinal variations of the perceived intensity within subjects. This thesis illustrates that FMRI can reveal subtle differences in the processing of clinical and experimental pain, despite brain activation patterns being similar on the whole. It also indicates that FMRI can be used to elucidate the origin of these differences, for instance by studying the influence of emotional and cognitive variables. This suggests that neuroimaging methods, in particular FMRI, have the potential to dissect clinical pain into its constituent parts, including central sensitization, brainstem facilitation and amplification by psychological factors. Such knowledge could potentially be exploited to target treatment selectively at different components of clinical pain and to monitor longitudinal changes of these components separately.
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Alperstein, Dion. "Predictors of Adherence to Pain Self-Management Strategies in Chronic Pain: Motivation to Change Pain Related Behaviour". Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/15930.
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Adherence to self-management strategies during multidisciplinary pain management interventions has been shown to be a significant predictor of pain outcomes. Despite these findings, the reasons patients adhere to self-management strategies is poorly understood. Therefore, it is difficult to know in what way to best improve adherence in order to maximise treatment-related gains. Readiness to adopt new pain behaviours has shown promise as a construct that can be used to predict adherence to prescribed pain behaviours.«br /» «br /» This research project comprised of an empirical study and a meta-analysis and systematic review. The meta-analysis and systematic review aimed to determine whether motivational interviewing approaches are effective in improving adherence, pain and physical function for patients with chronic pain. The results from seven studies indicate that MI leads to short-term increases in adherence to chronic pain treatments, although publication bias cannot be ruled out as an explanation for the findings. Further, it is as yet unclear whether these effects result in improvements in patient function.«br /» «br /» After establishing preliminary evidence that motivational interviewing approaches increase adherence to chronic pain treatment, an empirical study was established to explore the potential mechanisms associated with such increases. The study was primarily designed to determine whether readiness to adopt pain self-management strategies predicted these behaviours in a three-week multidisciplinary pain management program. The study also explored the relationship between individual’s beliefs about the perceived benefit in using self-management strategies and adherence to these strategies. The treating clinical psychologist rated participants adherence to each self-management strategy taught in the pain management program at the end of each week using a scale of 0 to 2, where 0 = ’not using the strategy at all’, 1 = ’using it inconsistently’, and 2 = ’using it consistently’.«br /» «br /» One hundred and nineteen participants consented to participate in the study. The major finding of this study was that individual’s perceived benefit in adopting self-management strategies early in treatment predicted small improvements in pain management coping behaviours in subsequent weeks of the program, particularly perceived benefit in the first week of the program. Interestingly, no strong bi-directional relationships were observed. That is, adherence did not predict individual’s perceived benefit in using self-management strategies in subsequent weeks. Contrary to expectations, readiness to adopt pain management strategies at baseline was not associated with adherence to self-management strategies during any week of the three-week program. Furthermore, this study failed to replicate the robust findings of past research that showed adherence to be an independent predictor of pain outcomes.«br /» «br /» The findings of this research project raises questions about the theoretical and clinical application of the transtheroetical model and the motivational model of pain self-management in chronic pain. Based on the findings, other health psychology models such as the health belief model may have more value for predicting adherence to chronic pain treatment. This research project also highlights the importance of individual’s expectancies and the process of change in chronic pain treatment. In particular, there is a need for more process-oriented research that assesses the temporal aspects of change so that an understanding of the mechanisms of change can be identified. This would in turn inform how current approaches to chronic pain treatment can be improved. Finally, the findings of the empirical study stress the need for valid and reliable measures of adherence that not only gauge participant adherence but therapist fidelity to therapeutic processes.
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Mahon, Mary L. "Pain perception in chronic pain patients : a signal detection analysis". Thesis, University of British Columbia, 1991. http://hdl.handle.net/2429/31127.
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The purpose of this investigation was to examine the supposition that chronic pain patients (CPPs) have altered pain perception. Two models were examined that led to opposing predictions as to how CPPs would respond to painful stimuli (i.e., the hypervigilance and adaptation-level models). Both predictions have been supported by past research but because of methodological variation and the type of pain disorder studied, it has remained unclear under what circumstances the predictions of these two models may be met.
The responses of pain patients to painful stimuli have been found to vary for patients-with different clinical presentations (i.e. those with and without medically incongruent signs and symptoms). Therefore, the present investigation sought to compare the responses to radiant heat stimuli of sixty CPPs (thirty with and thirty without a medically incongruent pain presentation) to thirty age and sex matched normal control subjects (i.e., pain-tree individuals). Signal detection theory methodology was used in order to separately evaluate sensory sensitivity and the response bias to report sensations as painful. In addition, cognitive and affective factors were assessed in order to identity potential psychological correlates of altered pain perception.
The results of this study indicated that the presence of a medically incongruent pain presentation distinguished patients on their subjective report of disability and to a lesser extent cognitive appraisal and affective distress regarding their pain condition. They did not differ in their responses to painful stimuli. In a post hoc analysis where CPPs were classified into 'organic' and 'functional’ diagnostic groups, significant differences in pain threshold and the response bias to report pain were found. Patients classified as 'organic' had significantly higher pain thresholds compared to normal control subjects and patients classified as 'functional'. Differences in pain threshold were primarily represented by the response' bias to report sensations as painful rather than sensory sensitivity to the stimuli. The 'functional' group had a slightly lower pain threshold than the normal control group but this difference was not significant. The results are discussed in light of the two models of pain perception. The two methods used to classify pain patients are discussed according to their orthogonal characteristics on sensory, cognitive, and affective components.Arts, Faculty of
Psychology, Department of
Graduate
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Liu, Xue Jun. "Peripheral regulation of inflammatory pain and neuropathic pain by adenosine". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/NQ66636.pdf.
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Gutke, Annelie. "Pelvic Girdle Pain and Lumbar Pain in relation to pregnancy". Doctoral thesis, Linköping : Univ, 2007. http://www.bibl.liu.se/liupubl/disp/disp2007/med998s.pdf.
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Ohnmeiss, Donna D. "Pain drawings in the evaluation of lumbar disc-related pain /". Stockholm, 2000. http://diss.kib.ki.se/2000/91-628-4069-X/.
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Olojugba, Oluwakanyinsola K. "The effect of pain site on the experience of pain". Thesis, University of Hull, 2009. http://hydra.hull.ac.uk/resources/hull:2391.
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This portfolio is made up of three parts. Part one is a systematic literature review in which the theoretical, conceptual and empirical literature relating to male and female experiences of chronic pain is reviewed. Part two is an empirical paper which uses IPA methodology to explore the influence of pain site on the female experience of chronic pain. Part three comprises the appendices
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凌綽姿 y Cheuk-chi Ling. "Evidence-based pain education programme for cancer patients with pain". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43251365.
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Rawle, Heather Margaret. "Circumstances of pain onset, blame, and adjustment in chronic pain". Thesis, University of Southampton, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.326857.
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Craine, Chloe I. y L. Lee Glenn. "Pain Assessment and Staff Attention to Pain in Nursing Homes". Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/7471.
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Excerpt: The conclusions by Boerlage, Masman, Hagoort, Tibboel, Baar, and Dijk (2010) were interesting, but the supports for the conclusions were weak because of a number of shortcomings. The many weaknesses would prevent the immediate adoption of those conclusions in a health care setting.
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Öjstedt, Erik y Simon Pankalla. "Clinical Assessment of Disturbed Central Pain Modulation in Orofacial Pain". Thesis, Malmö universitet, Odontologiska fakulteten (OD), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-19798.
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Syfte. Studiens syfte var att retrospektivt undersöka vilka kliniska variabler, bedömda under specialistundersökning av orofacial smärta, som kan förutsäga närvaro av en störd central smärtmodulering (DCPM). Material och metod. DC/TMD-data hämtades ur patientjournaler från 86 patienter som undersökts på Orofaciala smärtenheten på Malmö Universitet under perioden september 2012 till och med december 2013. Undersökta variabler omfattade smärtintensitet, smärtutbredning, smärtrelaterad nedsatthet, psykosociala variabler, refererad smärta samt kliniska fynd under somatosensoriska undersökningar. Baserat på denna data delades patienterna upp i en DCPM-grupp och en grupp utan DCPM. Allodyni, hyperalgesi, dysestesi, wind-up, regional/generell smärtutbredning samt eftersensation ansågs vara markörer för DCPM. Icke-parametriska statistiska analyser användes och en sannolikhetsnivå på P<0,05 ansågs vara signifikant. Resultat. Graden av ospecifika fysiska symptom och antalet refererande smärtor var signifikant högre i DCPM-gruppen. Den multivariata logistiska regressionen visade att ospecifika fysiska symptom, stress, smärtduration, smärtintensitet, smärtrelaterad nedsatthet, antalet refererande smärtpunkter, maximal gapning med och utan smärta, ångest samt antalet smärtinducerande käkrörelser var signifikanta marörer för DCPM (LR Chi2 = 26.89, p = 0.003, Pseudo R2 = 0.29). Slutsats. Denna studie indikerar att stress, ångest, smärtduration, smärtintensitet, smärtrelaterad nedsatthet, antalet refererande smärtpunkter, maximal gapning med och utan smärta samt antalet smärtinducerande käkrörelser är associerat med DCPM hos patienter med orofacial smärta.Objective. To retrospectively investigate clinical variables that can predict the presence of disturbed central pain modulation (DCPM). Material and methods Medical records of 86 patients examined at the Orofacial Pain Unit at Malmö University from September 2012 to December 2013 were examined regarding pain intensity, pain distribution, pain-related disability, psychosocial variables, referred pain as well as somatosensory changes. Based on these variables, the patients were divided into a disturbed central pain modulation (DCPM) group and a non-DCPM group. Allodynia, hyperalgesia, dysesthesia, increased wind-up, regional/general pain distribution and aftersensation were considered as markers for DCPM. Non-parametric statistics were used and a probability level of P<0.05 was considered as significant. Results. The degree of unspecific physical symptoms and the number of sites eliciting pain referral were significantly higher in the DCPM group. In the multivariate regression model, the independent variables physical symptoms, stress, pain duration, characteristic pain intensity, pain-related disability, number of sites with referred pain, maximum mouth opening with and without pain, anxiety, and number of pain eliciting jaw movements significantly predicted DCPM (LR Chi2 = 26.89, p = 0.003, Pseudo R2 = 0.29). Conclusion. This study indicates that stress, anxiety, orofacial pain and its consequences, unspecific physical symptoms and jaw dysfunction are clinical signs of DCPM in patients with orofacial pain. Also, high number of palpations sites with referred pain over the masseter and temporal muscles and the TMJ indicate presence of DCPM.
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Bennett, Michael I. "The development of a pain scale for identifying neuropathic pain". Thesis, University of Birmingham, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487879.
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Ling, Cheuk-chi. "Evidence-based pain education programme for cancer patients with pain". Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43251365.
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Herman, Julie L. "Nurses' pain management knowledge and patient outcomes related to pain". Muncie, Ind. : Ball State University, 2009. http://cardinalscholar.bsu.edu/464.
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Perry, Mark Paul. "Does age moderate self-pain enmeshment in chronic pain patients?" Thesis, University of Leeds, 2013. http://etheses.whiterose.ac.uk/5505/.
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Research has demonstrated that chronic pain can compromise identity by becoming enmeshed and centralised with pain. Pain-identity enmeshment and pain-identity centrality are associated with greater affective distress and poorer chronic pain adjustment. However, the literature infers differences between older and younger individuals in terms of pain adjustment, whereby older adults perceive pain as concomitant of aging and experience this as less biographically disruptive and perceive themselves to be younger than their chronological age, which is associated with greater psychological wellbeing. Research has yet to explore the relationship between perceived age and pain-identity enmeshment and adjustment in chronic pain. The purpose of this research was to investigate age in relation to pain-identity enmeshment and centrality and to examine the predictive value of age in pain adjustment. 90 patients with osteoarthritis (OA) and chronic pain were recruited from a musculoskeletal service. Participants completed standardised measures of pain intensity and perceived control (VAS), pain severity and interference (BPI), acceptance (CPAQ), identity (CES, Possible Selves Interviews), affective distress (HADS), and catastrophising (PCS) and provided information regarding their perceived age. Statistical analysis included; correlation, chi square, analysis of variance and linear regression to investigate potential age differences. Chronological age evidenced few significant relationships with variables of pain adjustment and identity. Perceived age evidenced significant relationships with all variables of adjustment and identity, however, did not statistically predict chronic pain adjustment. However, hoped-for proximity and centrality significantly predicted chronic pain adjustment. The CES demonstrated significant relatedness to enmeshment, although effect sizes were small. Therefore, it appears possible that an individual may experience pain becoming central to their identity yet remain un-enmeshed with pain. These findings indicate the necessity to assess hoped-for proximity and centrality in chronic pain populations across all age groups. This research indicates the potential for incorrectly perceiving expectedness and adjustment ease in old age. The implications of these findings are explored, in conjunction with the limitations of this research and potential areas for further research.
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McNiece, Cheryl Marie. "The nurse-patient communication process: Cancer pain and pain management". Diss., The University of Arizona, 2002. http://hdl.handle.net/10150/280197.
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Purpose. Explore how nurses and patients talk about cancer pain management during an oncology clinic visit. Describe the elements of these interactions and the patient-researcher discussions in order to evaluate the communication process used to report pain and to plan pain management. Design. Exploratory design of nurse-patient oncology clinic interactions and patient-researcher discussions. Methods. Nurse participants completed (1) a questionnaire about clinic time spent with patients and (2) Ward's Barrier Questionnaire (BQ) which concerns beliefs about the use of analgesics. Patient participants also completed a questionnaire about pain and Ward's BQ. Nurse-patient clinical interactions were audio-taped and analyzed by means of narrative analysis. Post-questionnaire patient-researcher discussions were analyzed also by narrative analysis. Quantitative data analysis was conducted on data from the questionnaires. Findings. Audio-taped nurse-patient interactions were divided by theme grouping into four summary examples: (1) Beginning to want to put it all together (56%), Communicating personal uniqueness (22%), (2) Active patient participation (13%), and (3) Learning about tests for future treatment (9%). Analysis revealed that while over 60% of the participants reported to be presently in pain, pain and pain management were rarely mentioned during the interactions. Patients did talk about pain extensively during the post-questionnaire discussions. Conclusions. Narrative analysis of nurse-patient interactions can provide health care professionals with examples of the quality and extent of information that cancer patients need regarding pain management. Not enough attention is given to patients' pain reports in the planning of pain management. Without systematic study of patients' pain reports and patients' comments on the effectiveness of analgesics, oncology clinic pain management will continue to remain inadequate.