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Background: Joint Hypermobility Syndrome (JHS) is a multisystemic connective tissue disorder characterised by pain, tissue fragility and laxity. This study aims to investigate the prevalence of chronic widespread pain (CWP) and the extended neurophysiological features reported by a group of patients with JHS. Methods: Ninety patients with JHS (mean age 34.7 ± 9.9 years), which was diagnosed in accordance with the Brighton criteria, and 113 healthy volunteers (mean age 35.7 ± 12.9) with no musculoskeletal pain participated in the study. A self-report questionnaire and pain chart were employed to collect data. Results: CWP was reported by 86% of patients with JHS. The mean number of pain sites in this group was 9.8/17 ± 4.2. Fibromyalgia was reported by 19% of this group. Patients with JHS were significantly more likely to report the following than healthy volunteers: autonomic symptoms (70%, 12%); gastrointestinal symptoms (71%, 9%); and chronic fatigue syndrome (31%, 1%). Patients with JHS reported significantly higher mean functional difficulties scores (22.28 ± 4.90) than healthy volunteers (17.96 ± 3.73) (P<0.001), indicative of functional difficulties associated with developmental coordination disorder/dyspraxia. Conclusion: Patients with JHS reported a wide range of neurophysiological symptoms of which CWP was a salient feature. There is a need to acknowledge and understand the extended symptoms associated with CWP in order to address the holistic needs of patients with JHS. Further studies and discussion are required to identify the complex inter-related multifactorial neurophysiological mechanisms in those with JHS. [ABSTRACT FROM AUTHOR]

Symphysis pubis dysfunction (SPD)/Pregnancy-related lumbopelvic pain (PLPP) is a common condition with a prevalence range of U-85% (Larsen et al, 1999; Orlikowski et al, 2006). In the literature, a number of terms and definitions have been employed by professionals from different countries to describe this condition. Women report a wide range of symptoms and there is a requirement for a careful assessment. The goal of this paper has been to raise awareness of the pain and activity limitations reported by some women during pregnancy and postpartum. The clinical presentation and women's experiences are described. The risk factors predisposing women to SPD/PLPP both during pregnancy and postpartum are presented. There is a requirement to meet the expectations of women with SPD/PLPP. Women need to be assessed, be able to tell their story, have the condition explained, and be involved in the management of their symptoms and activity limitations. Midwives play a key role in assessing for SPD/PLPP, so this paper proposes a five-step plan to guide midwives and doctors in the management of this condition. [ABSTRACT FROM AUTHOR]

(1) Background: Chronic pain is a significant and prevalent condition in many industrialized nations. Pain and sleep's reciprocal nature suggests that interventions to improve sleep may decrease pain symptoms. Little attention has been paid to the influence that owning a pet dog has on the pain/sleep relationship. Typical advice to remove pets from the bedroom negates the possible positive benefit of human-animal co-sleeping. Aim: To investigate pain patients' perceived impact of pet dog ownership on sleep. (2) Methods: We carried out a content analysis of interview data focused on the impact of pet dog ownership on sleep. The qualitative dataset comes from a subgroup of participants in a larger study examining the pain patient/canine relationship. This subgroup of participants from the larger study was asked, "Does your dog have a positive or negative impact on your sleep?" The data were thematically coded using an iterative approach. (3) Findings: Codes included: companionship; physical presence/'cuddles'; routine/schedule; distraction from anxiety/worry at night; reassuring/protective presence; active intervention to keep participant safe; daytime activity to promote sleeping at night; and reciprocal concern for the sleep of the pet dog. (4) Conclusions: Pet dogs may play important roles in helping people with chronic pain achieve sleep onset and maintenance. Removing the dog to improved sleep could be counter-productive and lead to additional sleep-related issues. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To understand the experiences of owners of dogs w ith chronic pain and explore owner perceptions of their pets' pain. DESIGN: Observational study. SAMPLE: 10 owners of dogs with chronic pain. PROCEDURES: Owners were interviewed by means of a semistructured and conversational technique. Interviews were then transcribed and analyzed with standard qualitative methodology to code fo r major themes. RESULTS: Major themes that were identified included changes in ow ner schedule, effects on owner relationships, and necessary resources when owning a pet with chronic pain. Owners discussed their perceptions of their pets' pain, and several participants referred to empathizing w ith their pet owing to their own experiences with pain. Owners also suggested ways that veterinarians can support them during the experience of owning a dog with chronic pain. CONCLUSIONS AND CLINICAL RELEVANCE: By understanding the impact of chronic pain on dog owners and appreciating how owners perceive pain in their pets, veterinarians may be able to provide better care for patients and clients. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The Relevance of Scholarship for Nursing Research and Practice," by A. Kitson in a 2006 issue.

Chronic low back pain is a significant societal and personal burden that negatively impacts quality of life. Dog ownership has been associated with health benefits. This study evaluated the feasibility of surveying people with chronic low back pain to assess the relationship between dog ownership and well-being. A mail-out survey was sent to 210 adult patients with chronic low back pain. Measures of quality of life, pain, physical activity, emotional health, social ties and dog ownership were included. Feasibility was assessed by examining survey response rate, responses to established and newly developed measures, and the potential relationships between dog ownership and a number of key well-being variables in this patient population. There were 56 completed surveys returned ( n = 36 non-dog owners and n = 20 dog owners). Established, adapted and newly developed scales revealed promising results. Dog owners reported fewer depression and anxiety symptoms, and more social ties than non-dog owners. Living with a dog may be associated with improved well-being for people with chronic pain. The findings from this feasibility study will inform a general population survey, to be conducted with a larger, more representative sample of people living with chronic pain.

Adult stem cells represent a potentially renewable and autologous source of cells to regenerate skin and improve wound healing. Firefighters are at risk of sustaining a burn and potentially benefiting from a split thickness skin graft (STSG). This mixed methods study examined firefighter willingness to participate in a future stem cell clinical trial, outcome priorities and factors associated with this decision., Methods: A sequential explanatory mixed methods design was used. The quantitative phase (online questionnaire) was followed by the qualitative phase (semi-structured interviews). A sample of 149 firefighters completed the online survey, and a purposeful sample of 15 firefighters was interviewed., Results: A majority (74%) reported they would participate in a future stem cell clinical trial if they experienced burn benefiting from STSG. Hypothetical concerns related to receiving a STSG were pain, itch, scarring/redness and skin durability. Participants indicated willingness to undergo stem cell therapy if the risk of no improvement was 43% or less. Risk tolerance was predicted by perceived social support and having children. Interviews revealed four main themes: a desire to help others, improving clinical outcomes, trusting relationships, and a belief in scientific investigation. Many participants admitted lacking sufficient knowledge to make an informed decision regarding stem cell therapies., Conclusions: Firefighters indicated they were largely willing to participate in a stem cell clinical trial but also indicated a lack of knowledge upon which to make a decision. Public education of the role of stem cells in STSG will be increasingly important as clinical trials are developed., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Aims: To determine key factors that stimulate and drive the ongoing interests of leaders in the field of pain to continue to work for change and to explore how they use their own experiences in their teaching., Background: The assessment and management of acute and chronic pain remains a challenge and the pain education of pre-licensure/undergraduate health professionals (e.g. nurses, physicians, etc.) continues to be suboptimal. Understanding the motivations of pain leaders may provide insights to facilitate the future development of pain clinicians., Design: A Narrative enquiry., Methods: A purposeful sample of 17 Canadian and USA leaders in pain education participated. Data were collected between September 2012-January 2013 using recorded semi-structured telephone interviews. Transcripts were coded to provide storied experiences (themes)., Findings: Six themes were identified as a stimulus for pain leaders: An early pain experience, mentorship and circumstances, a personal shift in understanding, catalysts (institutional or political), recognition of barriers and a determination to improve. Their work towards change appeared to be motivated by their pain 'quest' where leaders embraced their personal experiences of pain, a need for social action and individual change., Conclusions: Educational approaches for health professionals usually focus on the importance of knowledge, skills and attitudes to be competent in pain care. To inspire and educate young health professionals about pain management we suggest the development of future pain leaders may require a different approach that recognizes personal stories of pain, includes a local pain champion and incorporates a model of mentorship., (© 2016 John Wiley & Sons Ltd.)

Objective: To evaluate the association between opioid dosage and ongoing therapy with physical function and disability in patients with neuropathic pain (NeP)., Design: Secondary analysis of a prospective cohort., Setting: Multicenter clinical NeP registry., Subjects: Seven hundred eighty-nine patients treated for various NeP diagnoses., Methods: The following measures were included: dependent variables. 12-month self-reported physical function (pain disability index [PDI] and medical outcomes study short form-12 physical function [PCSS-12]); independent variables: baseline opioid dose (none, ≤200 mg and >200 mg of morphine equivalent), ongoing opioid use; potential confounding variables: age, sex, baseline pain intensity, and psychological distress (profile of mood states). Analysis of covariance models was created to examine the relationship between opioid therapy and both physical functioning outcomes with adjustment for confounding., Results: Complete data was available for 535 patients (68%). Compared with the lower and high dose opioid groups, NeP patients not taking opioids had statistically lower disability and higher physical functioning scores, after adjusting for disease severity. Compared with patients prescribed opioid therapy on an ongoing basis, NeP patients who were not prescribed had statistically lower disability and higher physical functioning scores, after adjusting for disease severity. Improvements in disability and physical functioning scores from baseline and 12-months in all groups were modest and may not be clinically significant., Conclusions: Physical functioning and disability did not improve in patients with NeP who were prescribed opioids compared with those who are not prescribed, even after adjusting for disease severity., (Wiley Periodicals, Inc.)

Aim: To determine the extent of clinically significant pain suffered by hospitalized patients during their stay and at discharge., Background: The management of pain in hospitals continues to be problematic, despite long-standing awareness of the problem and improvements, e.g. acute pain teams and patient-controlled analgesia, epidural analgesia. Poorly managed pain, especially acute pain, often leads to adverse physical and psychological outcomes including persistent pain and disability. A systems approach may improve the management of pain in hospitals., Design: A descriptive cross-sectional exploratory design., Method: A large electronic pain score database of vital signs and pain scores was interrogated between 1st January 2010 and 31st December 2010 to establish the proportion of hospital inpatient stays with clinically significant pain during the hospital stay and at discharge., Findings: A total of 810,774 pain scores were analysed, representing 38,451 patient stays. Clinically significant pain was present in 38·4% of patient stays. Across surgical categories, 54·0% of emergency admissions experienced clinically significant pain, compared with 48·0% of elective admissions. Medical areas had a summary figure of 26·5%. For 30% patients, clinically significant pain was followed by a consecutive clinically significant pain score. Only 0·2% of pain assessments were made independently of vital signs., Conclusion: Reducing the risk of long-term persistent pain should be seen as integral to improving patient safety and can be achieved by harnessing organizational pain management processes with quality improvement initiatives. The assessment of pain alongside vital signs should be reviewed. Setting quality targets for pain are essential for improving the patient's experience., (© 2013 John Wiley & Sons Ltd.)

Background: Patients' as well as doctors' expectations might be key elements for improving the quality of health care; however, previous conceptual and theoretical frameworks related to expectations often overlook such complex and complementary relationship between patients' and doctors' expectations. The concept of 'matched patient-doctor expectations' is not properly investigated, and there is lack of literature exploring such aspect of the consultation., Aim: The paper presents a preliminary conceptual model for the relationship between patients' and doctors' expectations with specific reference to back pain management in primary care., Methods: The methods employed in this study are integrative literature review, examination of previous theoretical frameworks, identification of conceptual issues in existing literature, and synthesis and development of a preliminary pragmatic conceptual framework., Outcome: A simple preliminary model explaining the formation of expectations in relation to specific antecedents and consequences was developed; the model incorporates several stages and filters (influencing factors, underlying reactions, judgement, formed reactions, outcome and significance) to explain the development and anticipated influence of expectations on the consultation outcome., Conclusion: The newly developed model takes into account several important dynamics that might be key elements for more successful back pain consultation in primary care, mainly the importance of matching patients' and doctors' expectations as well as the importance of addressing unmet expectations., (© 2011 John Wiley & Sons Ltd.)

Background: Back pain is a common disorder, with the doctor being the first point of contact for help. Biopsychosocial management of back pain has been shown to be problematic. Meeting patients' expectations is alleged to play a vital role in concordance, adherence and satisfaction. A more potent aspect, however, could be a state of matched patient- doctor expectations with regard to the consultation process and outcome, but this aspect has not been fully investigated and there is currently no valid and specific measure of this dimension., Aim: To report on the development of a newly designed patient and doctor expectations questionnaire that measures the matching of their expectations with regard to the back pain consultation in primary care, and to establish the validity and internal consistency of the new tool., Methods: A literature review was carried out and a draft 36-item questionnaire was developed. Thirty-eight subjects (7 researchers, 20 patients and 11 doctors) tested the questionnaire. Each subject gave feedback on the questionnaire design and was also asked to fill in a previously validated tool, the Patients' Intentions Questionnaire (PIQ), to establish the concurrent validity of the newly designed expectations questionnaire. Construct validity was established by calculating the Spearman correlation coefficient, and Cronbach's alpha was computed to reflect the internal consistency of the instrument., Findings: The results of the validity questionnaire showed that the questionnaire was perceived as simple, clear and easy to understand and appropriate to the intended aim. Spearman correlation coefficients between the Patients' Expectations Questionnaire and PIQ showed significant correlation ( r = 0.65), reflecting good concurrent validity, while Cronbach's alpha was 0.831, reflecting good internal consistency., Conclusion: The newly designed questionnaire showed good face, content and construct validity as well as good internal consistency, and thus can be used as a valid and reliable measure for back pain-specific expectations of the process and outcome of the consultation in primary care settings.

Introduction: Studies exploring the role of patients in interprofessional education (IPE) are found primarily in undergraduate programmes with few reporting on the postgraduate (continuing professional development) setting. This paper describes an interprofessional quality improvement project around the management of back pain in a primary care setting where patients were part of the practice team., Methods: Patients participated in eight half-day IPE workshops delivered to nine general practice teams in the UK. Educational content included knowledge about quality improvement and evidence-based back pain knowledge, with teamwork, experiential and didactic learning approaches. On-site practice support from a quality improvement facilitator occurred between the workshops to strengthen practice-based learning. Forty-four practice staff and 11 patients attended the workshops and the facilitated project meetings. Evaluation occurred through focus groups with practice teams (including patients) both before and after the workshops. These were recorded, transcribed and analysed by coding and the inductive development of themes., Results: The context of managing back pain was particularly challenging. Focus group participants indicated that patient involvement was highly valued as it gave practitioners a greater understanding of the effects of back pain on their lives whilst permitting patients to hear the experiences of others and to understand their own world better. Listening was important to patients' experiences of healthcare and practitioners' experiences of the workshops. Learning together emerged as particularly important and finally the challenge of finding time to learn together infiltrated the entire endeavour and was a prominent concern., Discussion: Patients sharing their experience of back pain appeared to be a particularly pivotal point in the learning for practice teams. Meaningful engagement with users in IPE was highly valued and provided a catalyst for behavioural change, where professionals relinquished an unhelpful medical model in favour of an integrative biopsychosocial one.

The prevalence and burden of pain has long been reported as problematic. Comprehensive pain education in undergraduate programmes is essential for developing knowledgeable, skilled and effective healthcare professionals. This cross-sectional survey describes the nature, content and learning strategies for pain curricula in undergraduate healthcare programmes in major universities in the United Kingdom (UK). Document analysis also highlighted gaps in pain-related standards from professional regulators and a higher education quality assurance body. The sample consisted of 19 higher education institutions delivering 108 programmes across dentistry, medicine, midwifery, nursing, occupational therapy, pharmacy, physiotherapy and veterinary science. Seventy-four (68.5%) questionnaires were returned averaging 12.0 h of pain content with physiotherapy and veterinary science students receiving the highest input. Pain education accounted for less than 1% of programme hours for some disciplines. Traditional teaching methods dominated (e.g. lectures 87.8%) and only two programmes had fully implemented the International Association for the Study of Pain's (IASP) curricula. Minimal pain-related standards were found from professional regulators and the quality assurance documents. Pain education is variable across and within disciplines and interprofessional learning is minimal. Published curricula for pain education have been available for over 20 years but are rarely employed and pain is not a core part of regulatory and quality assurance standards for health professions. The hours of pain education is woefully inadequate given the prevalence and burden of pain. Recommendations include the introduction of pain-related educational standards across all professions, greater integration of pain content in undergraduate programmes and interprofessional approaches to the topic., (Copyright © 2011 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.)

Aim: This paper is a report of a study exploring patients' use of analgesics following day case surgery, with particular focus on patients' decision-making about analgesic use., Background: Day case and ambulatory surgery continue to be the preferred format for many elective surgical procedures. However, many patients' experience unacceptable postoperative pain when they return home after day surgery. Previous research investigating barriers to pain management suggests that patients may not use their analgesics appropriately., Method: A qualitative approach using interpretative phenomenological analysis was used to explore the experiences of 28 patients admitted for day case surgery. The patients were interviewed on the fourth postoperative day. Data were collected in 2005-06., Findings: We identified an explanatory framework with three high level themes and 12 mid-level themes, with the mid-level themes broken down into a number of lower level themes. Patients' use of analgesics was a complex intentional decision-making process based on a matrix of beliefs surrounding pain, analgesics and day surgery. They did not always adhere to their analgesic regimes at home, many describing how they avoided analgesics and often withstood high levels of postoperative pain., Conclusion: Interventions need to go beyond the provision of pain management information (as in current practice), and overcome some of the erroneous beliefs held by patients. Further research is required to identify ways in which these erroneous beliefs can be overcome.

Aim: The purpose of this paper is to critically explore the sequential explanatory mixed method research design and how it can enhance our understanding of pain management., Background: The general prevalence of pain after surgery has not changed significantly over several decades despite the widespread introduction of new pain relieving technologies. The majority of postoperative pain studies use quantitative methods which offer little understanding of the underlying processes of care. Understanding can be illuminated by using an explanatory mixed method research design., Design: Discursive paper., Method: This paper focuses on the methodological considerations when using a mixed method design. Two previously published mixed methods studies illustrate how findings can inform practice. In the first, 85 women undergoing surgery completed questionnaires to measure pain, anxiety and depression. Telephone interviews explored their pain experiences. The second study considered frequency and patterns of anxiety in the immediate pre and postoperative period. Semi-structured telephone interviews, identified contributing events/situations amenable to nursing intervention., Discussion: Reasons for growing popularity, criticisms, paradigmatic considerations and epistemological roots of pragmatism are explored. The two explanatory mixed method studies provide examples of these studies and how 'inferences' from quantitative and qualitative data can inform practice., Conclusion: This paper connects quantitative and qualitative data, drawing on two research studies, to give greater understanding to the management of pain. Knowledge of the processes responsible for inadequate pain management can be illuminated by using explanatory mixed methods research designs., Relevance to Clinical Practice: Nursing requires knowledge which reflects the complexity of human health. The explanatory mixed method study can elucidate the problem under scrutiny, e.g. prevalence of pain or anxiety. The qualitative phase can generates an understanding of contributing factors and insights for care delivery. The implicit desire to change and influence practice makes it relevant for those closely aligned to practice.

This study sought to explore the impact of the psychological variables anxiety and depression, on pain experience over time following surgery. Eighty-five women having major gynaecological surgery were assessed for anxiety, depression and pain after surgery. To gain further understanding, 37 patients participated in a semi-structured taped telephone interview 4-6 weeks post-operatively. Pre-operative anxiety was found to be predictive of post-operative anxiety on Day 2, with patients who experienced high levels of anxiety before surgery continuing to feel anxious afterwards. By Day 4 both anxiety and depression scores increased as pain increased and one-third of the sample experienced levels of anxiety in psychiatric proportions whilst under one-third experienced similar levels of depression. These findings have significant implications for the provision of acute pain management after surgery. Future research and those managing acute pain services need to consider the multidimensional effect of acute pain and the interface between primary and secondary care.