Pain Management Commons^™

Treating Chronic Pain At A Federally Qualified Health Center: Staff Perspectives, Nathan K. Goins

Doctor of Psychology (PsyD)

Although half of all patients with chronic pain seek treatment with their primary care practitioner, many physicians report being overburdened, with limited confidence in their training in the treatment of chronic pain. Opiate monotherapy remains the most common treatment utilized, despite strong correlations with addiction issues and increased distrust between patients and providers. In response to these issues, multidisciplinary stepped-care approaches utilizing psychoeducation, cognitive therapies, movement-based therapy, pharmaceutical treatment, yoga, and acupuncture have been developed. However, treatment within Federally Qualified Health Centers (FQHC) are complicated by financial constraints and high complexity in patient populations. This study examined the perspectives of …

Suicidal Ideation In Patients Hospitalized For Emergency Medical Treatment Related To Physical Trauma: Effects Of Posttraumatic Stress And Depression, Erin E. Carney

Masters Theses & Specialist Projects

Survivors of physical trauma may be at increased risk for developing suicidal ideation and behavior both during and after their inpatient hospitalization for medical treatment of wounds. It remains to be understood why a population hospitalized for nonpsychiatric reasons may ultimately develop a desire to take their own life. The current study sought to answer this question by hypothesizing that symptoms of posttraumatic stress (PTS) and depression during the recovery period individually mediated the relationship between physical pain and suicidal ideation. Researchers assessed these relationships in 246 patients who were receiving emergency medical treatment for wounds associated with a physically …

Perspectives On Pediatric Pain, Donald E. Greydanus, Dilip R. Patel, Colleen Dodich, Hatim A. Omar, Joav Merrick

Pediatrics Faculty Publications

No abstract provided.

Phantom Limb Pain, Stephanie J. Stockburger, Mandakini Sadhir, Hatim A. Omar

Pediatrics Faculty Publications

Phantom limb pain is pain that is perceived in a part of the body which is no longer present. It is estimated that 80 percent of amputees experience phantom limb pain. Although the term is “phantom limb pain” the feeling is often more of a burning, twisting, itching, or pressure sensation than pain. The exact mechanism of phantom limb pain is unknown although proposed mechanisms include pain origination from either the central nervous system or the peripheral nervous system. Since the exact mechanism of phantom limb pain is unknown, treating this pain may be difficult. Treatments include pharmacological and nonpharmacological. …

Use Of Video Games In Patients' Self-Management Of Pain: A Feasibility Study, Janet Donnelly Phd(C), Rn-Bc, Acns-Bc, Pccn

Dissertations

Background: Pain affects more than 75 million Americans and is the primary reason people seek medical attention. Pain is a common cause of disability and diminished quality of life. While anecdotal evidence exists regarding nurses’ use of distraction therapy activities in pain management, little empirical research data is available.

Purpose: To examine the effects of video game use (VGU) on pain perception, pain interference perception and perceived self-efficacy in pain management in adult inpatients.

Conceptual Model: The conceptual model is based on Self-efficacy Theory (Bandura, 1995). The antecedents of the concept of distraction therapy with use of VGs in patients’ …

Chronic Pain Causal Attributions In An Interdisciplinary Primary Care Clinic: Patient-Provider And Provider-Provider Discrepancies, Bryan Jensen

Theses and Dissertations

The purpose of the present study was to investigate the influence of pain causal attributions on patient pain-related functioning, treatment engagement, and clinical outcomes. Additionally, the impact of discordant pain causal attributions between patients and their providers as well as between interdisciplinary providers was examined. Patients rated their pain functioning and causal pain attributions during a regular clinic visit. Following the patient’s visit both the behavioral medicine provider and internal medicine resident provided ratings of similar pain-related functioning domains and causal attributions. Follow-up data were collected from the electronic medical record three months following that clinic visit. Overall, results revealed …

Ouch, That Hurts: Childbirth-Related Pain Management And The Inappropriate Replacement Of Traditional Obstetrical Knowledge In Kumaon, Uttarakhand, India, Sabrina Zionts

Independent Study Project (ISP) Collection

Throughout India, obstetrical knowledge and practice has been developed and passed down by generations of women. In many Indian societies, traditional birth attendants, or dais, remain the gatekeepers of childbirth-related knowledge. Yet with the push towards institutional delivery, traditional knowledge and practices are being increasingly replaced with modern and Western ones. While the trend of hospital deliveries has yielded positive health outcomes, its socio-cultural consequences remain unclear. Situated in Uttarakhand’s Kumaon Himalayas, this study employs a bio-social framework and begins to reveal these consequences. Using labor pain management as an entry point, this study argues that the push towards institutional …

Uncovering Meanings Of Death, Trauma, And Loss As Experienced By Hospice Bereavement Coordinators: A Phenomenological Study, Rochelle S. Clarke

Department of Family Therapy Dissertations and Applied Clinical Projects

This study examined the experiences of Hospice Bereavement Coordinators (HBCs) and Hospice Chaplains working with grief narratives from patient-family units exhibiting signs of anticipatory or complicated grief. While a significant amount of research has been conducted on Hospice employees, no qualitative studies have examined the interpretation of meaning from employees whose primary role focused on the psychosocial-spiritual aspects of clients exhibiting anticipatory or complicated grief. The researcher identified shared meaning of death, trauma, and loss from six participants in the context of a high stress and high loss environment. This study‘s findings revealed ten central themes: Death is an earthly …

The Feasibility Of Implementing A Novel Electrical Stimulation Device In The Self-Management Of Hand Burn Pain, Katrina Liddiard

Theses : Honours

Burns are widely acknowledged as one of the most painful injuries experienced, and poorly controlled pain following burn injury has been linked to reduced psychological adjustment, lower quality of life, and increased risk of developing a chronic pain state. Transcutaneous electrical nerve stimulation has been used for pain relief in a range of medical conditions, and may have the potential to reduce pain and analgesic consumption for burns patients. The burn care environment presents unique challenges to the introduction of new interventions, and the feasibility of introducing a novel form of electrical stimulation into this environment has not been tested. …

Trauma In Patients With Serious Mental Illness: The Acceptability And Impact Of A Brief Psychoeducational Intervention For Trauma In The General Acute Inpatient Psychiatric Setting, Kevin E. A. Giangrasso

PCOM Psychology Dissertations

Prevalence rates of posttraumatic stress disorder (PTSD) for individuals with serious mental illnesses (SMIs) are high, with an estimated 49% to 100% being exposed to potentially traumatic events. The consequences of these disorders are serious and lasting, with PTSD being the costliest of mental health disorders. At the same time, established evidence-based treatments for PTSD are often not feasible in treatment settings utilized by individuals with SMIs, namely the general acute inpatient psychiatric hospital. Psychoeducational approaches have been incorporated as a component of evidence-based interventions for trauma and have been feasibly implemented in the general acute inpatient psychiatric hospital. The …

How Patients' Self-Disclosure About Sickle Cell Pain Episodes To Significant Others Relates To Living With Sickle Cell Disease, Valerian J. Derlega, Louis H. Janda, Jeannie Miranda, Ian A. Chen, B. Mitchell Goodman Iii, Wally Smith

Psychology Faculty Publications

Objectives: This cross-sectional study examines to whom and how fully sickle cell disease (SCD) patients talk to others about sickle cell pain, how helpful it is to talk with others about these pain episodes, and the association between talking to others about sickle cell pain episodes and patients' psychological adjustment and coping strategies in managing the disease.

Methods: A convenience sample of 73 African American patients with SCD (30 men and 43 women), were recruited from two SCD clinics at the time of routine medical visits. Most participants had been diagnosed with hemoglobin SS, and they reported an average number …

Acute Cerebellitis With Hydrocephalus, Nida Amjad, Anwarul Haque, Khalid Ahmed

Department of Paediatrics and Child Health

We report a case of an 8 years old child who presented with sudden onset of headache and vomiting. He had broad-based gait and intention tremors on admission. MRI brain revealed isointense signals on T1-weighted imaging and hyperintense signals on T2-weighted imaging. Cerebellar swelling was also identified with significant mass effect obliterating the fourth ventricle. CT head showed prominent third and lateral ventricles. He was treated with high dose corticosteroids and required an external ventricular drain (EVD) insertion. He made an uneventful recovery and suffered no neurologic deficit. The clinical and radiologic findings in this boy were consistent with cerebellitis …

The Association Of Religious Coping On Reports Of Low Back Pain And Inflammatory Markers, Jacqueline D. Bougie

Loma Linda University Electronic Theses, Dissertations & Projects

Chronic pain is the most common cause of disability in the United States with depression, anxiety, and stress often occurring co-morbidly. The purpose of the study was to explore how religion may modulate the frequency of back pain, influence inflammatory markers, influence the use of medications, and impact functional ability.

Participants were from the Biological Manifestations of Religion Study (BioMRS; N= 508) and the Psychological Manifestations of Religion Study (PsyMRS; N = 10,988). All participants completed a 20-page questionnaire and BioMRS participants provided blood, salivary, and urine samples, performance tests, and learning tests all collected within 1 week of …

Chronic Spontaneous Activity Generated In The Somata Of Primary Nociceptors Is Associated With Pain-Related Behavior After Spinal Cord Injury, Supinder S Bedi, Qing Yang, Robyn J Crook, Junhui Du, Zizhen Wu, Harvey M Fishman, Raymond J Grill, Susan M Carlton, Edgar T Walters

Faculty, Staff and Student Publications

Mechanisms underlying chronic pain that develops after spinal cord injury (SCI) are incompletely understood. Most research on SCI pain mechanisms has focused on neuronal alterations within pain pathways at spinal and supraspinal levels associated with inflammation and glial activation. These events might also impact central processes of primary sensory neurons, triggering in nociceptors a hyperexcitable state and spontaneous activity (SA) that drive behavioral hypersensitivity and pain. SCI can sensitize peripheral fibers of nociceptors and promote peripheral SA, but whether these effects are driven by extrinsic alterations in surrounding tissue or are intrinsic to the nociceptor, and whether similar SA occurs …

Acute Musculoskeletal Sports Injury And Topical Nsaid, Amit M. Deokar, Shawn J. Smith, Hatim A. Omar

Pediatrics Faculty Publications

The objective of this chapter is to summarize the current standards of pain management in minor sports related musculoskeletal injuries. We also address the topical form of non-steroidal anti-inflammatory drug as an effective pain management option in an out-patient setting. Design: Quantitive systematic review of randomized controlled trials. Methods: The data was obtained through literature review of articles published in the last 10 years. In addition, FDA information on non-steroidal anti-inflammatory medications was also reviewed. The patient population studied in the articles included children and adults. Conclusion: Current standards of managing pain resulting from sports injuries involve a number of …

A Psychoeducational Group Intervention For Fibromyalgia Patients, Derek O. Bacchus

Loma Linda University Electronic Theses, Dissertations & Projects

This study examined the effect of a multidisciplinary psychoeducational treatment group on Fibromyalgia Syndrome (FMS) pain, depression, catastrophizing, and quality of life. The Short-Form McGill Pain Questionnaire (SF-MPQ), Center for Epidemiologic Studies Depression Scale (CES-D), Coping Strategies Questionnaire (CSQ), and the World Health Organization Quality of Life Assessment—Abbreviated Version were used to assess these constructs in 15 participants. The sample was composed entirely of female participants and was predominantly middle aged, which is typical of the FMS population. Two separate groups of FMS patients—seven in Group 1, eight in Group 2—completed a 10-week psychoeducational intervention where they were presented with …

Molluscan Memory Of Injury: Evolutionary Insights Into Chronic Pain And Neurological Disorders, Edgar T Walters, Leonid L Moroz

Faculty, Staff and Student Publications

Molluscan preparations have yielded seminal discoveries in neuroscience, but the experimental advantages of this group have not, until now, been complemented by adequate molecular or genomic information for comparisons to genetically defined model organisms in other phyla. The recent sequencing of the transcriptome and genome of Aplysia californica, however, will enable extensive comparative studies at the molecular level. Among other benefits, this will bring the power of individually identifiable and manipulable neurons to bear upon questions of cellular function for evolutionarily conserved genes associated with clinically important neural dysfunction. Because of the slower rate of gene evolution in this molluscan …

Use Of Topical Nsaids In Acute Musculoskeletal Sports Injury: A Brief Review, Amit M. Deokar, Shawn J. Smith, Hatim A. Omar

Pediatrics Faculty Publications

The objective of this chapter is to summarize the current standards of pain management in minor sports-related musculoskeletal injuries. This chapter also addresses the topical form of non-steroidal anti-inflammatory drug as an effective pain management option in an outpatient setting. Design: Quantitive systematic review of randomized controlled trials. Methods: The data was obtained through literature review of articles published in the last 10 years. In addition, FDA information on non-steroidal anti-inflammatory medications was also reviewed. The patient population studied in the articles included children and adults. Conclusion: Current standards of managing pain resulting from sports injuries involve a number of …

The Relations Of Pain, Religious Coping, And Depression In Fibromyalgia Patients, Derek O. Bacchus

Loma Linda University Electronic Theses, Dissertations & Projects

This study attempted to examine the relationship between Fibromyalgia Syndrome (FMS) pain, religious coping, and depression. The Fibromyalgia Impact Questionnaire (FIQ), Short-Form McGill Pain Questionnaire (SF-MPQ), RCOPE, and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess these constructs in 50 participants. The sample was primarily middle aged and female, which is typical of the FMS population. This study used multiple regression to make assumptions about the causal progression of the variables. Study findings show that religious coping does not appear to significantly mediate the strong relationship between FMS pain and depression. This research served to uncover …

Training Program To Improve Estimation Of Patients' Periodontal Pain Experience, Yoon Jeong Kim

Loma Linda University Electronic Theses, Dissertations & Projects

Background: The purpose of this study was to determine if periodontal residents could enhance their ability to appraise the pain levels experienced by their patients from probing, using Visual Analog Scale (VAS) to record pain. We hypothesized that with increasing experience by repeated comparisons of the patients' VAS pain ratings with independent ratings by the residents, they would improve their ability to appraise their patients' pain experiences.

Methods: For each of three periodontal residents, 40 consecutive periodontitis patients were asked to express the degree of pain they experienced during the probing. Independently, the residents rated the pain level they perceived …

The Effects Of An Analgesic (Biofreeze®) On The Motoneuron Pool Excitability Of The Soleus Muscle, Desiree R. Barth

All-Inclusive List of Electronic Theses and Dissertations

Objective: The purpose of this study was to determine the effects on the Hoffman reflex and motor response with an analgesic (Biofreeze®). Design: The study was a 2X6 design. The independent variables in this study were treatment and time. The dependent variables were the H-reflex (volts) and the M response (volts). Treatment was randomly assigned to control for the effects of order. Setting: This study took place in the Exercise Physiology Laboratory located in the Health and Human Performance Building at Indiana State University. Subjects: 14 volunteers who were physically active and had no known neurological problems. Measurements: Skin and …

Nurses' Perceptions Of The Pharmacological Management Of Acute Pain Experienced By Patients Hospitalised In The General Ward Setting, Susan Slatyer

Theses : Honours

This study explored and described the experiences and perceptions of nurses managing acute pain in a Western Australian public hospital. The focus was nurses practising in the general ward setting and using current prescribing guidelines. The aim of this research was to explore nurses' attitudes, beliefs and knowledge about pain and pain pharmacology and how this practice setting influences efficient pain management. Qualitative methodology was selected for its ability to explore complex issues in order to build nursing knowledge and guide nursing practice. This study used a descriptive, exploratory design based on a phenomenological approach. The sample comprised ten Registered …

Pain Experienced By Patients Using Thinner Vs. Thicker Probes During Probing, Mohamed A. Hassan

Loma Linda University Electronic Theses, Dissertations & Projects

The aim of the present study, performed during periodontal recall visits, was to compare the levels of pain experienced by patients during periodontal probing using probes with tip diameters of either 0.40 mm or 0.63 mm.

Prior to the maintenance procedures, three groups of 20 adult patients were examined by 3 different therapists. Diagonal maxillary/mandibular quadrants were probed with a 0.40 mm and a 0.63 mm probe, respectively. At the completion of probing of each quadrant, the patients were asked to describe their pain using a Visual Analog Scale (VAS).

The results were as follows: Most patients showed low VAS …

Pain Experienced By Patients During Periodontal Examination, Mohammed A. Al-Ajmi

Loma Linda University Electronic Theses, Dissertations & Projects

The aims of the present study were to determine the level of pain experienced by patients from probing during periodontal examination, and to find out to what extent the examining periodontist and the dental assistant could estimate the degree of pain experienced by the patients.

For each of three periodontists, 20 patients referred for periodontal diagnosis and treatment were selected. The periodontist carried out his examination, which included probing at six sites per tooth. Following probing, the patients rated the pain using a Visual Analog Scale (VAS). The periodontist and the dental assistant who helped out during the examination independently …

Update - July 2002, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- Having Enough Faith Not To Be Healed
-- Theological Warrants for Palliative Care
-- Congratulations (master program graduates)

Pain Experienced By Patients During Periodontal Recall Treatment, Thu-Diem Chung

Loma Linda University Electronic Theses, Dissertations & Projects

The aims of this study were to determine; 1) the degree of pain experienced by patients during probing and debridement; 2) if the treating hygienists could estimate the degree of pain experienced by the patients; and 3) if the patients' pain responses could be predicted by factors such as the patients' age, gender, number of residual periodontal lesions, and the patients' answers to a questionnaire on dental anxiety.

Prior to the maintenance procedures, 2 groups of 20 adult patients to be treated by 2 hygienists completed an anxiety questionnaire. Subsequently, measurements of probing depths were performed, followed by pain ratings …

Chronic Pain: A Study Of Low Back Pain Patients From Southern West Virginia And Eastern Kentucky, Nickandrea M. Cooke

Theses, Dissertations and Capstones

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) was administered to 60 males ranging from 22 to 65 years of age. Subjects were seeking treatment at Mountain Comprehensive Care Center, an outpatient mental health center, for depression/anxiety with a secondary diagnosis of chronic pain stemming from low back pain related to an injury. This study considered T-scores of a K-corrected profile using Scales F (Faking, 1 (Hypochondriasis), 2 (Depression), and 3 (Hysteria). Statistical interpretation of data was obtained through use of the General Linear Model at the p < .05 level of significance to determine variance among the groups. Subjects were assigned to three of six groups based on the criteria of age (less than 35 years vs. 35 years or older); duration of pain (less than one year's duration vs. one year or more duration); and medical evidence available (with clinical evidence to support an orthopedic diagnosis vs. those with no clinical evidence available). The results of this study showed that there was no significant difference between groups on the age variable and the only significant differences on the medical evidence variable were for Scales 2 (D) and 3 (Hy). On the duration of pain variable, significant differences among groups for all scales were noted. Also, chronic low back pain patients from this geographic area presented with extreme elevations on Scale F and high elevations on Scales 1 (Hs), 2 (D), and 3 (Hy), with a higher elevation on Scale 2 (D).

Update - March 1999, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- Mark Carr, Richard Rice and Siroj Sorajjakool join LLU Faculty of Religion
-- Scholars, Clinicians, and Patients Highlight February Palliative Care Conference
-- [ The Meaning of Pain and Suffering ]
-- MA in Clinical Ethics
-- MA in Clinical Ministry

Temperature And Pain Changes Resulting From Post Surgical (Arthroscopy) Application Of Cold Packs, Caroline L. Creager

All-Inclusive List of Electronic Theses and Dissertations

Post-surgical cold applications are beneficial to orthopedic surgery patients. However, their use is limited because of the difficulty in maintaining a constant temperature, increased need for attention, and unwanted leaks or condensation from ice bags. Twenty-one arthroscopic surgery patients were divided into three groups: a Dura*Kold cold pack group, an Aircast Cryo/cuff compression dressing group, and a control group. Six dependent variables were examined: subjective pain ratings three and 48 hours after surgery, a subjective rating of functional activity 48 hours after surgery, skin temperature for three hours after surgery, and pain medication consumed during three hours and 48 hours …

Introducing The Living With Illness Group: A Specialized Treatment For Patients With Chronic Schizophrenic Conditions, Thomas G. Plante, Stephanie L. Pinder, David Howe

Psychology

This paper introduces a specialized psychotherapy/psychoeducational group treatment for patients with chronic psychotic symptoms who receive only partial benefit from psychotropic medications, psychotherapy, and milieu/activities therapy. The goal of the group is to assist patients to accurately identify the feelings, thoughts, and behaviors that are dysfunctional symptoms of their disability and then use the functional aspects of their brain as well as learned coping strategies to compensate for their disability. The group format, philosophy, procedures, and typical topics of discussion are detailed.