Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

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An Introduction To The Event Related Potential Technique

Chronic pain is one of the most prevalent health problems in our modern world, with millions of people debilitated by conditions such as back pain, headache and arthritis. To address this growing problem, many people are turning to mind-body therapies, including meditation, yoga and cognitive behavioural therapy. This article will review the neural mechanisms underlying the modulation of pain by cognitive and emotional states - important components of mind-body therapies. It will also examine the accumulating evidence that chronic pain itself alters brain circuitry, including that involved in endogenous pain control, suggesting that controlling pain becomes increasingly difficult as pain becomes chronic.

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Cognitive and emotional control of pain and its disruption in chronic pain

The effect of pain on cognitive function: a review of clinical and preclinical research.

Sleep plays a vital role in brain function and systemic physiology across many body systems Problems with sleep are widely prevalent and include deficits in quantity and quality of sleep; sleep problems that impact the continuity of sleep are collectively referred to as sleep disruptions Numerous factors contribute to sleep disruption, ranging from lifestyle and environmental factors to sleep disorders and other medical conditions Sleep disruptions have substantial adverse short- and long-term health consequences A literature search was conducted to provide a nonsystematic review of these health consequences (this review was designed to be nonsystematic to better focus on the topics of interest due to the myriad parameters affected by sleep) Sleep disruption is associated with increased activity of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, metabolic effects, changes in circadian rhythms, and proinflammatory responses In otherwise healthy adults, short-term consequences of sleep disruption include increased stress responsivity, somatic pain, reduced quality of life, emotional distress and mood disorders, and cognitive, memory, and performance deficits For adolescents, psychosocial health, school performance, and risk-taking behaviors are impacted by sleep disruption Behavioral problems and cognitive functioning are associated with sleep disruption in children Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer All-cause mortality is also increased in men with sleep disturbances For those with underlying medical conditions, sleep disruption may diminish the health-related quality of life of children and adolescents and may worsen the severity of common gastrointestinal disorders As a result of the potential consequences of sleep disruption, health care professionals should be cognizant of how managing underlying medical conditions may help to optimize sleep continuity and consider prescribing interventions that minimize sleep disruption

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Short- and long-term health consequences of sleep disruption.

Background Sleep problems exist for up to 30% of young people, and increase in the case of those with chronic pain. Because exclusive pharmacological management of sleep problems for children with pain is contraindicated, the development of appropriate non-pharmacological sleep interventions is a significant, largely unmet, need. Purpose This study examined whether the application of a standardized hand self-shiatsu (HSS) intervention within a population of young people with chronic pain would be associated with improved objectively and subjectively measured sleep. Setting The Pain Management Clinic of the Stollery Children's Hospital Hospital, a large tertiary care centre in Edmonton, Alberta and the University of Alberta. Research design Sixteen young adults, aged 17 to 27, were recruited for a case series study. The intervention involved participants self-applying a standardized hand shiatsu protocol. Participants wore an actigraph for one week at baseline before learning the HSS technique, and then at four- and eight-week follow-up. At the same measurement points they completed validated self-report measures of their sleep quality and daytime fatigue. Each participant also completed a sleep log to supplement the actigraphy data and to collect their general impressions of the HSS experience. Data were analyzed with SPSS 23 software, using Freidman's test for analysis of variance. Results The objective data did not support the hypothesis that this standardized HSS protocol improves objectively measured sleep. However, standardized self-report measures demonstrated statistically significant improvement in perceived sleep disturbance (chi-squared test [χ2] = 8.034, p = .02), sleep-related impairment (χ2 = 7.614, p = .02), and daytime fatigue as measured by the PROMIS Fatigue SF 8-a (χ2 = 12.035, p = .002), and the Flinder's Fatigue Scale (χ2 = 11.93, p = .003). Qualitative sleep log information indicated wide-spread endorsement of HSS for the management of sleep difficulties. Conclusion Contrary to objective findings, self-report data support the technique of HSS to improve sleep. Participants' comments reflected an overall high level of acceptance and appreciation for the HSS technique. Results highlight the importance of expanding the theory and practice related to sleep measurement to better integrate the qualitative domain.

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Effectiveness of Hand Self-Shiatsu to Promote Sleep in Young People with Chronic Pain: a Case Series Design.

Accurate and reliable assessment of pain in children is critical since a large portion of this population cannot verbally communicate and describe any pain they are experiencing. However, the inability of many young children to adequately report pain or discomfort makes pain assessment in pediatric patients difficult. A variety of different pain scales and reporting tools have been developed to facilitate pain assessment for each pediatric age group, from neonates to adolescents. Additionally, specialized pain reporting scales have been developed to allow pain assessment in critically ill children and children with developmental delays. This chapter outlines the principles and concepts underlying pain assessment and reporting in children and discusses some of the factors that influence pain assessment in the pediatric population. Examples of currently available pain assessment tools are also provided, and their uses, advantages, and disadvantages are discussed.

Pain Assessment in Children Undergoing Regional Anesthesia

Purpose The prognosis of persistent back pain is variable, with some individuals adjusting poorly and others continuing to actively engage in work and other valued social roles. The aim of this study was to better understand why some individuals, despite persistent back pain, continue to actively engage in work and other valued social roles. Methods Individuals with persistent back pain, who were participating in their regular duties as a full-time employee, homemaker, student or any combination of these, were recruited from a multidisciplinary pain centre and orthopedic physical therapy clinics in Alberta, Canada. A qualitative study was conducted using semi-structured interviews of 15 participants and a thematic analysis to analyze the data. Results There were two motivators identified for participating in the work role: (1) participation formed part of the participant’s self-schema (a cognitive framework that includes one’s beliefs about oneself) and (2) participation made it possible to achieve a valued outcome. Conclusions Further understanding of important motivators for maintaining engagement in work and other valued social roles despite persistent back pain can help inform the development of more successful disability and pain management programs.

Bruce D. Dick

Papers

Effectiveness of Hand Self-Shiatsu to Promote Sleep in Young People with Chronic Pain: a Case Series Design.

Pain Assessment in Children Undergoing Regional Anesthesia

What Motivates Engagement in Work and Other Valued Social Roles Despite Persistent Back Pain

Association between sleep disordered breathing and symptoms of attention deficits in adults: a systematic review.

The effect of a cognitive-behavioral therapy chronic pain management program on perceived stigma: A clinical controlled trial.