Grief symptoms and difficult patient loss for oncologists in response to patient death.

Science.gov (United States)

Granek, Leeat; Ben-David, Merav; Shapira, Shahar; Bar-Sela, Gil; Ariad, Samuel

2017-07-01

The study aimed to explore oncologist's grief symptoms over patient death and to identify why and which losses are particularly challenging when patients die. The grounded theory method was used to collect and analyze the data. Twenty-two oncologists were interviewed between March 2013 and June 2014 from three adult oncology centers in the north, center, and south of Israel. Oncologists were at different stages of their careers and varied in their sub-specialties, gender, and personal and professional backgrounds. Grief begun when the patient died, in anticipation of the patient's death, many days after the death, or when the patient received a poor prognosis. The phenomenological experience of grief for oncologists included behavioral, cognitive, physical, and emotional symptoms in response to patient death. Behavioral symptoms included crying and difficulties sleeping. Cognitive symptoms included self-doubt and rumination about the patient and the care the patient had received before death. Physical symptoms included chest pain, fatigue, and general physical discomfort. Emotional symptoms included sadness, anxiety, helplessness, guilt, relief, irritability, and loss. Difficult patient loss was caused by patient-related factors, family-related factors, and disease-related factors. Patient deaths result in behavioral, cognitive, physical, and emotional symptoms of grief in oncologists. These symptoms become particularly intense in the context of patient, family, and disease-related factors. Educational and supportive interventions for managing grief related to patient death are needed in order to support oncologists in their emotionally and mentally taxing work. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Potential Use of Ayahuasca in Grief Therapy.

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González, Débora; Carvalho, María; Cantillo, Jordi; Aixalá, Marc; Farré, Magí

2017-01-01

The death of a loved one is ultimately a universal experience. However, conventional interventions employed for people suffering with uncomplicated grief have gathered little empirical support. The present study aimed to explore the potential effects of ayahuasca on grief. We compared 30 people who had taken ayahuasca with 30 people who had attended peer-support groups, measuring level of grief and experiential avoidance. We also examined themes in participant responses to an open-ended question regarding their experiences with ayahuasca. The ayahuasca group presented a lower level of grief in the Present Feelings Scale of Texas Revised Inventory of Grief, showing benefits in some psychological and interpersonal dimensions. Qualitative responses described experiences of emotional release, biographical memories, and experiences of contact with the deceased. Additionally, some benefits were identified regarding the ayahuasca experiences. These results provide preliminary data about the potential of ayahuasca as a therapeutic tool in treatments for grief.

Bereaved parents’ online grief communities

DEFF Research Database (Denmark)

Christensen, Dorthe Refslund; Hård af Segerstad, Ylva; Kasperowski, Dick

2017-01-01

This article presents results from case studies of online grief communities for bereaved parents in Denmark and Sweden (Christensen & Sandvik 2013, 2015a; Hård af Segerstad & Kasperowski, 2015), analyzing how development of practices and norms for grieving and mourning online are related...... to the conditions for participation in the online forums, and to dominant ideas of grief in society as such. Rooted in contemporary research on grief and mourning, we discuss practices of tabooization, de-tabooization or even re-tabooization in the different online forums and how norms and traditions are performed...

Financial Perils in Higher Education--Good Grief!

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Shaw, Kenneth A.; Britton, Thomas C.

The premise that institutions pass through a grief process in adjusting to declining resources and radical changes, is proposed. In addition, strategies that administrators can use to respond to institutional grief are suggested. Elisabeth Kubler-Ross's paradigm of five grief stages/reactions to serious loss are described: denial, anger,…

The Nothingness of the Anguish in Søren Kierkegaard’s work as Modernity’s Infernal Redemption

Directory of Open Access Journals (Sweden)

Francisc-Norbert Ormeny

2015-09-01

Full Text Available The intention of this short study is to discuss the reverberations of Søren Kierkegaard’s philosophical considerations on anguish and on void in the context of the latest postmodern theoretical trends (Ben Woodard’s dark vitalism, by presenting the mechanisms by means of which the anguish gets to produce an “existential switch” which extracts the individual from the register of disintegration and introduces him into the register of the project (Heideggerianly speaking. I will try to demonstrate the compatibility between the structures of the late modernity and the Kierkegaardian vision on tension and on paradox, and will I will attempt to connect the possible findings to the relevant and congenial phenomenological, existentialist and aesthetic theories or set of theories circulating in today’s exegetical canon

Grief: Helping Young Children Cope

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Wood, Frances B.

2008-01-01

In their role as caregivers supporting the children they teach, it is important for teachers to understand the grieving process and recognize symptoms of grief. The author explains Elisabeth Kubler-Ross's five stages of grief and offers 10 classroom strategies to help young children cope with their feelings.

Neuropsychological correlates of complicated grief in older spousally bereaved adults.

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O'Connor, Mary-Frances; Arizmendi, Brian J

2014-01-01

Across many research domains, evidence for complicated grief as a distinct psychopathology continues to grow. Previous research from neuropsychology has shown an increased attentional bias to emotionally relevant stimuli in those suffering from complicated grief. This study furthers our understanding of the characteristics that distinguish complicated grief. We expand on previous research by (a) testing older adults, (b) excluding those with comorbid major depressive disorder, (c) using participant-chosen grief-related stimuli, and (d) using a married, nonbereaved control group. We recruited 76 older adults in 3 groups: spousally bereaved with complicated grief, spousally bereaved with noncomplicated grief, and nonbereaved controls. Performance on the Wisconsin Card Sorting Task, Digit Span Backwards, and the emotional counting Stroop was examined. Results indicate longer reaction time across 3 blocks of grief-related words in the complicated grief group but no difference across 3 blocks of the neutral words. The 3 groups performed comparably on the other neurocognitive tasks, indicating no cognitive differences in working memory or set shifting between groups. Furthermore, these effects of complicated grief generalize to older adults and appear independent of major depression. Complicated grief has cognitive interference as a neuropsychological component highlighting it as distinct from noncomplicated grief.

The Grief Account: Dimensions of a Contemporary Bereavement Genre

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Dennis, Michael Robert

2008-01-01

The genre of the grief account is identified to include published narratives of surviving grief. Thematic analysis of Andrew Holleran's (2006) "Grief: A Novel," Lolly Winston's (2004) "Good Grief: A Novel," Joan Didion's (2005) "The Year of Magical Thinking," and J. Canfield and M. V. Hansen's (2003) "Chicken Soup for the Grieving Soul: Stories…

Concept clarification of grief in mothers of children with an addiction.

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Zucker, Donna M; Dion, Kimberly; McKeever, Roxanna P

2015-04-01

To report an analysis of the concept of grief in mothers of children with an addiction. The concept of grief in this context is poorly understood and often synonymously used with concepts depression, loss and chronic sorrow. In the US, the core concept grief has been recently revised by both NANDA and the DSM-V in efforts to better understand and characterize the concept. The plethora of literature on grief worldwide often characterizes grief as a response to a death. Concept analysis. Search terms 'parental grief' and 'substance abuse' yielded 30 articles. A second review using terms 'grief' and 'substance abuse' yielded 323 articles, in PsychInfo, CINAHL, PubMed databases from 1980-2013. Limits for articles in English and for the terms 'death' and 'child' yielded 13 usable articles. The hybrid model of concept analysis, using a theoretical phase, an empirical phase and a final phase when a clarified definition of grief emerged. Definitions in the literature and defining characteristics of grief outline bio-psycho-social aspects of the concept. For one mother grief was accompanied by recurring feelings of sadness across time, while for the other mother grief was seen as coping, after having passed through a variety of stages of grief. For both, grief was seen to fall on a continuum. Grief is a universal concept and has a trajectory. Case study data have been essential in clarifying understandings of grief as experienced by mothers of addicted children and will provide direction for meaningful and tailored interventions. © 2014 John Wiley & Sons Ltd.

Planting hope in loss and grief: self-care applications of horticultural therapy for grief caregivers in Taiwan.

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Lin, Yeh-Jen; Lin, Chi Yun; Li, Yu-Chan

2014-01-01

In 2008, the Taiwan Association for Care and Counseling for Loss organized a workshop about Horticultural Therapy, conducted as a participatory action research (PAR). Nineteen grief caregivers participated. Specific goals were designed according to a survey of participant expectations and focus-group discussions. The workshop content included lectures and interactive activities. Results demonstrated that most participants displayed an increased awareness of personal loss and meaning in grief, indicating that horticulture and nature appreciation might relieve individual grief and stress. The report introduces the rationale, evolution, execution, and results of the program development.

Abnormal Grief: Should We Consider a More Patient-Centered Approach?

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Moayedoddin, Babak; Markowitz, John C

2015-01-01

Grief, the psychological reaction to the loss of a significant other, varies complexly in its cause, experience, evolution, and prognosis. Although most bereaved individuals experience a normal grieving process, some develop complicated grief (CG) or major depressive disorder (MDD). The DSM-5, which controversially altered the nosology, recognizes grief-related major depression (GRMD) as a diagnostic subtype if a patient meets MDD criteria two weeks post bereavement. The (DSM-5) tries to distinguish between grief and MDD, but remains a symptom-based, centered approach to grief that is not patient centered. This article reviews grief in its normal and abnormal dimensions. Using an illustrative clinical case in which interpersonal psychotherapy (IPT) was employed, we discuss the need for a more patient-centered approach to treating abnormal grief, considering the patient's personal history, perceptions, experiences of bereavement, and interpersonal environment. Clinical studies need to better identify subgroups of individuals susceptible to abnormal grief and to evaluate their response to early interventions.

The Grief Resolution Process in Divorce.

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Crosby, John F.; And Others

1983-01-01

Compares grief in divorce to the Kubler-Ross model of grief resolution in bereavement in 17 persons who wrote essays about their divorce. The results suggested a conceptual model based on three chronological stages with linear progression through the stages, characterized by circularity within each stage. (JAC)

Attitudes of palliative care clinical staff toward prolonged grief disorder diagnosis and grief interventions.

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Davis, Esther L; Deane, Frank P; Barclay, Gregory D; Bourne, Joan; Connolly, Vivienne

2017-07-03

The provision of psychological support to caregivers is an important part of the role of the clinical staff working in palliative care. Staff knowledge and attitudes may determine their openness to referring caregivers to a psychological intervention. We recently developed a self-help intervention for grief and psychological distress among caregivers and were interested in exploring the extent to which staff knowledge and attitudes might affect future implementation. The aims of our study were to: (1) examine the acceptability of self-help psychological intervention for caregivers among palliative care clinical staff; (2) examine potential attitudinal barriers toward prolonged grief disorder (PGD) as a diagnosis and interventions for grief; and (3) bolster staff confidence in skills and knowledge in identifying and managing caregiver psychological distress. An anonymous survey was distributed among clinical staff at two inpatient units and two community health services that assessed the acceptability of self-help interventions for caregivers, attitudes about PGD diagnosis and grief intervention, and staff confidence in skills and knowledge in assessing caregiver psychological distress. Overall, clinical staff were positively oriented toward self-help for caregivers and intervention for grief. They were also basically confident in their skills and knowledge. While it was positive PGD attitudes that were associated with acceptability of self-help for caregivers, it was both positive and negative PGD attitudes that were associated more specifically with a willingness to refer caregivers to such an intervention. Our findings are useful in highlighting the issues to be considered in the implementation of a self-help intervention within the healthcare service. Clinical staff seemed positively oriented toward engaging with a psychological intervention for caregivers and likely to act as key allies in implementation.

A confirmatory factor analysis of the Harvard Trauma Questionnaire and the Inventory of Complicated Grief-Revised: Are we measuring complicated grief or posttraumatic stress?

DEFF Research Database (Denmark)

O'Connor, Maja; Lasgaard, Mathias Kamp; Shevlin, Mark

2010-01-01

  The Inventory of Complicated Grief Revised (ICG-R) assesses symptoms of complicated grief in bereaved individuals. The aim of this study was to assess the factorial structure of Complicated Grief (CG) and investigate the relationship between CG and Posttraumatic Stress Disorder through the asse......  The Inventory of Complicated Grief Revised (ICG-R) assesses symptoms of complicated grief in bereaved individuals. The aim of this study was to assess the factorial structure of Complicated Grief (CG) and investigate the relationship between CG and Posttraumatic Stress Disorder through...... and the three factors of PTSD, as defined by the DSM-IV (American Psychiatric Association, 1994), were allowed to correlate provided the best fit. The results therefore indicate high levels of conceptual overlap among the dimensions of CG and PTSD....

Making Stories and Taking Stories: Methodological Reflections on Researching Grief and Marital Tension following the Death of a Child.

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Riches, Gordon; Dawson, Pam

1996-01-01

Explores some of the methodological issues which arose during an investigation into experiences of bereaved parents. Notes the values of ethnographic approaches in researching intimate and painful experiences and argues that parents' stories about their children's lives are central to processes of identity reconstruction during grief. (RJM)

Integrating Buddhist Psychology into Grief Counseling

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Wada, Kaori; Park, Jeeseon

2009-01-01

The field of grief counseling has yet to see an integration of Buddhist psychology. Drawing on Buddhist psychology literature and Western models of grief, this article explores possible integrations of two approaches. To lay the foundation for this discussion, the authors introduced a brief overview of the history of Buddhism as well as a Buddhist…

Tweeting Prayers and Communicating Grief over Michael Jackson Online

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Sanderson, Jimmy; Cheong, Pauline Hope

2010-01-01

Death and bereavement are human experiences that new media helps facilitate alongside creating new social grief practices that occur online. This study investigated how people's postings and tweets facilitated the communication of grief after pop music icon Michael Jackson died. Drawing on past grief research, religion, and new media studies, a…

The impact of bereaved parents' perceived grief similarity on relationship satisfaction.

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Buyukcan-Tetik, Asuman; Finkenauer, Catrin; Schut, Henk; Stroebe, Margaret; Stroebe, Wolfgang

2017-06-01

The present research focused on bereaved parents' perceived grief similarity, and aimed to investigate the concurrent and longitudinal effects of the perceptions that the partner has less, equal, or more grief intensity than oneself on relationship satisfaction. Participants of our longitudinal study were 229 heterosexual bereaved Dutch couples who completed questionnaires 6, 13, and 20 months after the loss of their child. Average age of participants was 40.7 (SD = 9.5). Across 3 study waves, participants' perceived grief similarity and relationship satisfaction were assessed. To control for their effects, own grief level, child's gender, expectedness of loss, parent's age, parent's gender, and time were also included in the analyses. Consistent with the hypotheses, cross-sectional results revealed that bereaved parents who perceived dissimilar levels of grief (less or more grief) had lower relationship satisfaction than bereaved parents who perceived similar levels of grief. This effect remained significant controlling for the effects of possible confounding variables and actual similarity in grief between partners. We also found that perceived grief similarity at the first study wave was related to the highest level of relationship satisfaction at the second study wave. Moreover, results showed that perceived grief similarity was associated with a higher level in partner's relationship satisfaction. Results are discussed considering the comparison and similarity in grief across bereaved partners after child loss. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The use of pathological grief outcomes in bereavement studies on African Americans.

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Granek, Leeat; Peleg-Sagy, Tal

2017-06-01

Pathological bereavement outcomes (i.e., complicated grief, traumatic grief, prolonged grief disorder) are a robust and growing research area in the psychological and medical sciences. Although grief is considered to be a universal phenomenon, it is well documented that grieving processes and outcomes are culturally and contextually bound. The objectives of this study were: (a) to examine representations of African Americans in the grief and mourning literature and to assess the extent to which this research utilizes pathological grief outcomes; and (b) to examine the characteristics of pathological grief constructs in the literature to assess their relevance for African American populations. We conducted comprehensive searches of three scientific databases including PsycNET, Medline, and CINAHL, which contain the majority of grief and mourning literature published between January 1998 and February 2014. We found 59 studies addressing grief and mourning in African Americans. Thirteen of these studies used pathological grief outcomes. Pathological grief outcomes that were constructed and validated on White populations were frequently used as outcome variables with African American participants. We discuss the implications for the grief and mourning field and argue that the failure to use culturally sensitive outcome measures in research studies is a form of epistemological violence that may have negative research and clinical implications for African Americans and other ethnic minorities.

Effectiveness of Psychotherapy-Based Interventions for Complicated Grief: A Systematic Review

Directory of Open Access Journals (Sweden)

Ozge Enez

2017-12-01

Full Text Available Grief is a normal, dynamic and multidimensional process, which relates to the individuality and uniqueness of reactions to loss. However, complicated grief is a syndrome where normal grief is unusually prolonged because of complications in the natural healing process. Approximately one third of grieving individuals develop complicated grief symptoms. The individuals suffering from complicated grief tend to report clinical complaints that refer to anxiety, depression, psychical symptoms and life-threatening behaviours. The aims of this study were: to identify which psychother-apy-based interventions were designed for the treatment of complicated grief; and to make an infer-ence about the effect of these interventions. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2017; 9(4.000: 441-463

Grief Processing and Deliberate Grief Avoidance: A Prospective Comparison of Bereaved Spouses and Parents in the United States and the People's Republic of China

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Bonanno, George A.; Papa, Anthony; Lalande, Kathleen; Zhang, Nanping; Noll, Jennie G.

2005-01-01

In this study, the authors measured grief processing and deliberate grief avoidance and examined their relationship to adjustment at 4 and 18 months of bereavement for 2 types of losses (spouse, child) in 2 cultures (People's Republic of China, United States). Three hypotheses were compared: the traditional grief work assumption, a conditional…

The Child in Grief: Implications for Teaching.

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Hare, Jan; And Others

The purpose of this paper is to increase teachers' understanding of children's conceptualizations of death to enable them to respond to the symptoms of grief in both early and middle childhood. John Bowlby's theoretical framework of childhood mourning is elaborated, and research on teachers' facilitation of children's grief is briefly noted. The…

Designing personal grief rituals: An analysis of symbolic objects and actions.

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Sas, Corina; Coman, Alina

2016-10-01

Personal grief rituals are beneficial in dealing with complicated grief, but challenging to design, as they require symbolic objects and actions meeting clients' emotional needs. The authors reported interviews with 10 therapists with expertise in both grief therapy and grief rituals. Findings indicate three types of rituals supporting honoring, letting go, and self transformation, with the latter being particularly complex. Outcomes also point to a taxonomy of ritual objects for framing and remembering ritual experience, and for capturing and processing grief. Besides symbolic possessions, the authors identified other types of ritual objects including transformational and future-oriented ones. Symbolic actions include creative craft of ritual objects, respectful handling, disposal, and symbolic play. They conclude with theoretical implications of these findings, and a reflection on their value for tailored, creative co-design of grief rituals. In particular, several implications for designing grief rituals were identified that include accounting for the client's need, selecting (or creating) the most appropriate objects and actions from the identified types, integrating principles of both grief and art/drama therapy, exploring clients' affinity for the ancient elements as medium of disposal in letting go rituals, and the value of technology for recording and reflecting on ritual experience.

Do Grief Self-Help Books Convey Contemporary Perspectives on Grieving?

Science.gov (United States)

Dennis, Michael Robert

2012-01-01

Grief therapy and psychology literatures of the modern Western world conceptualized bereavement and grief as processes to be "worked through" so that other relationships could be pursued. In the last decade or so, however, grief theorists have endorsed the value of attaining new meaning(s) and continuing bonds with our lost loved ones instead of…

Effectiveness of a grief intervention for caregivers of people with dementia

OpenAIRE

MacCourt, Penny; McLennan, Marianne; Somers, Sandie; Krawczyk, Marian

2017-01-01

In this article, we report on the structure and effectiveness of a grief management coaching intervention with caregivers of individuals with dementia. The intervention was informed by Marwit and Meuser’s Caregiver Grief Model and considered levels of grief, sense of empowerment, coping, and resilience using five methods of delivery. Results indicate that the intervention had significant positive effects on caregivers’ levels of grief and increased their levels of empowerment, coping, and res...

Do grief self-help books convey contemporary perspectives on grieving?

Science.gov (United States)

Dennis, Michael Robert

2012-01-01

Grief therapy and psychology literatures of the modern Western world conceptualized bereavement and grief as processes to be "worked through" so that other relationships could be pursued. In the last decade or so, however, grief theorists have endorsed the value of attaining new meaning(s) and continuing bonds with our lost loved ones instead of "moving on from," "letting go of" or "achieving closure from" them. This article tracks the evolution of thought pertaining to this shift and examines its relevance to grief self-help books that may offer Americans guidance in the ways of grieving.

Memorial video tribute and the enfranchised grief of a gay widower

OpenAIRE

Pentaris, Panagiotis

2014-01-01

Doka (2008) introduced the term ‘disenfranchised grief ’ to refer to the form of grief that lacks social recognition. This paper argues that disenfranchised grief can find recognition and support via online communities, and it introduces this as enfranchised grief. Media and communication technologies have been widely used to communicate death and dying, while a vast number of the population, globally, has access to the information. Numerous deaths of celebrities have been covered by the news...

Effectiveness of a Grief Intervention for Caregivers of People With Dementia.

Science.gov (United States)

MacCourt, Penny; McLennan, Marianne; Somers, Sandie; Krawczyk, Marian

2017-08-01

In this article, we report on the structure and effectiveness of a grief management coaching intervention with caregivers of individuals with dementia. The intervention was informed by Marwit and Meuser's Caregiver Grief Model and considered levels of grief, sense of empowerment, coping, and resilience using five methods of delivery. Results indicate that the intervention had significant positive effects on caregivers' levels of grief and increased their levels of empowerment, coping, and resilience. The intervention was found to be effective across caregivers' characteristics as well as across five delivery modalities. Through description of this intervention, as well as outcome, this research contributes to the body of knowledge about caregivers' disenfranchised grief and ways to effectively address it.

Psychometric Properties of the Grief Cognitions Questionnaire for Children (GCQ-C)

NARCIS (Netherlands)

M. Spuij (Mariken); P.J. Prinzie (Peter); P.A. Boelen (Paul A.)

2017-01-01

textabstractNegative thinking is seen as an important mediating factor in the development of prolonged grief disorder (PGD), a syndrome encompassing debilitating symptoms of grief. No measure of specific grief related cognitions is available yet. Based on an adult measure of negative thinking in

Psychometric Properties of the Grief Cognitions Questionnaire for Children (GCQ-C)

NARCIS (Netherlands)

Spuij, Mariken; Prinzie, Peter; Boelen, Paul A.

2017-01-01

Negative thinking is seen as an important mediating factor in the development of prolonged grief disorder (PGD), a syndrome encompassing debilitating symptoms of grief. No measure of specific grief related cognitions is available yet. Based on an adult measure of negative thinking in adults we

The grief process for patient, family, and physician.

Science.gov (United States)

Bruce, Christine A

2002-09-01

In the grieving process, patient, family, and health professionals have the same needs-rest, relaxation, nourishment, a sense of security, trust, hope in the future, and humor among them. Grief, defined as a shared, universal, and natural neuropsychobiologic expression in response to loss, is distinct from mourning, a practice that varies in expression across diverse cultures. To aid in an understanding of grief and its effects, the author looks at the models for grief proposed by Kubler-Ross, Bowlby, Parkes, Worden, and Wolfelt. Addressing patients' concerns requires physicians be empathic, attentive, and respective and have willingness to take time, be present, and listen.

Ecological grief as a mental health response to climate change-related loss

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Cunsolo, Ashlee; Ellis, Neville R.

2018-04-01

Climate change is increasingly understood to impact mental health through multiple pathways of risk, including intense feelings of grief as people suffer climate-related losses to valued species, ecosystems and landscapes. Despite growing research interest, ecologically driven grief, or `ecological grief', remains an underdeveloped area of inquiry. We argue that grief is a natural and legitimate response to ecological loss, and one that may become more common as climate impacts worsen. Drawing upon our own research in Northern Canada and the Australian Wheatbelt, combined with a synthesis of the literature, we offer future research directions for the study of ecological grief.

Mental Pain and Suicide

DEFF Research Database (Denmark)

Verrocchio, Maria Cristina; Carrozzino, Danilo; Marchetti, Daniela

2016-01-01

ideation than depression. Conclusion: Mental pain is a core clinical factor for understanding suicide, both in the context of mood disorders and independently from depression. Health care professionals need to be aware of the higher suicidal risk in patients reporting mental pain. In this regard......Background: Mental pain, defined as a subjective experience characterized by perception of strong negative feelings and changes in the self and its function, is no less real than other types of grief. Mental pain has been considered to be a distinct entity from depression. We have performed...... a systematic review analyzing the relationship between mental pain and suicide by providing a qualitative data synthesis of the studies. Methods: We have conducted, in accordance with PRISMA guidelines, a systematic search for the literature in PubMed, Web Of Science, and Scopus. Search terms were "mental pain...

Alexithymia and Grief Reactions in Bereaved Japanese Women

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Nakao, Mutsuhiro; Kashiwagi, Masayo; Yano, Eiji

2005-01-01

To examine the relationship between grief reactions and alexithymia, 54 Japanese women (33 outpatients attending a psychosomatic clinic and 21 normal healthy participants) completed the Texas Inventory of Grief (TIG), the 20-item Toronto Alexithymia Scale (TAS-20), and the Profile of Mood States (POMS). Each woman had experienced the death of a…

Public stigma of prolonged grief disorder : An experimental study

NARCIS (Netherlands)

Eisma, Maarten C.

Prolonged grief disorder (PGD), characterized by severe, persistent and disabling grief, is being considered for inclusion in the International Classification of Diseases’ 11 (ICD-11) and a related disorder, Persistent Complex Bereavement Disorder (PCBD), is included for further investigation in the

Parental Grief Following the Death of a Child from Cancer: The Ongoing Odyssey.

Science.gov (United States)

Snaman, Jennifer M; Kaye, Erica C; Torres, Carlos; Gibson, Deborah; Baker, Justin N

2016-09-01

The death of a child is a devastating event that results in profound grief and significant psychosocial and physical morbidities in parents. The parental grief journey is a complex phenomenon necessitating the utilization of newer models of bereavement with a focus on relationships and exploration of parents' perceived meanings of the experience. To further characterize the grief journey of parents whose child died from cancer in order to better identify parents who can benefit from additional bereavement support and design strategies to improve bereavement services for these parents. We conducted focus group sessions with 11 bereaved parents. The parents were given two prompts to describe their grief journey before and after their child's death, and their responses in a narrative form were audio-recorded. The responses were coded and studied independently by semantic content analysis. Collation and analysis of the coded responses to both prompts results in the emergence of four concepts from the parental narratives: (1) description of the grief trajectory and evolution of grief over time, (2) mechanisms of parental coping throughout the grief journey, (3) factors that exacerbate parental grief, and (4) sources of parental support throughout the grief journey. The narratives highlighted that parents whose child died of cancer experience a unique and evolving form of grief and they wish to continue their bond with the deceased child. We recommend that healthcare providers and institutions incorporate support systems into a comprehensive bereavement program for families of children who die from cancer. © 2016 Wiley Periodicals, Inc.

Understanding Grief and Loss

Science.gov (United States)

... the process of adapting to life after a loss. It is influenced by each person’s society, culture, and religion. Bereavement is the state of having experienced a loss. Common grief reactions Reactions to loss are called ...

Behind the smile: qualitative study of caregivers’ anguish and management responses while caring for someone living with heart failure

Science.gov (United States)

Frost, Julia; Britten, Nicky

2017-01-01

Background Caregivers support self-management in heart failure but often experience stress, anxiety and ill health as a result of providing care. Aims 1. To identify the factors that contribute to the experience of anguish. 2. To understand how caregivers learn to live with what is frequently a challenging and demanding role. Methods Individual interviews with caregivers who had been caring for someone with heart failure for a minimum of 6 months. We used thematic analysis to inductively analyse transcripts. Results Twenty-two caregivers, from three centres in the United Kingdom, took part in individual interviews. The caregivers were aged between 39 and 84 years, and six were men. Twenty were in spousal or partner relationships. We found that caregivers often hide the extent of their emotional stress or anguish. We identified four main themes with explanatory subthemes—emotional impact (fear for the future and sense of hopelessness), role definition (changing sense of who I am, reduced resilience, learning care skills, role conflict and changing role), exclusion (exclusion by the cared-for person and by health professionals and feeling alone) and ignoring one’s own health—that were associated with anguish. From these findings, we produced a caregiver needs assessment model in the context of caring for a person with heart failure. Conclusions and implications for practice Caregivers have many unmet and hidden needs. Primary care health professionals are well placed to meet the needs of caregivers. The model may be used by health and social care professionals to identify needs and to provide caregivers with targeted practical and emotional support; and for researchers developing interventions to enhance self-management in heart failure. PMID:28733297

Factors Underlying the Relationship Between Parent and Child Grief.

Science.gov (United States)

Cipriano, David J; Cipriano, Madeline R

2017-01-01

The death of a parent in a child's life is a significant risk factor for later mental and physical health problems. While much has been written about the surviving parent's functioning and its effects on their bereaved children, little work has been done to look into factors underlying this effect such as how the parent copes. The present study recruited 38 parent-child dyads from a community-based grief support center. Parent and child, independently, completed various measures of emotional functioning, including grief symptoms and coping such as social support and locus of control. The results indicated that parental coping did have an impact on children's grief symptoms. This represents a unique view of adaptation in bereaved children: Parental coping strategies can have an impact on the child, independent of the child's coping strategies. By focusing on parent coping, we have highlighted another possible pathway through which parental functioning affects children's grief.

Cultural perspectives of death, grief, and bereavement.

Science.gov (United States)

Clements, Paul T; Vigil, Gloria J; Manno, Martin S; Henry, Gloria C; Wilks, Jonathan; Das Sarthak; Kellywood, Rosie; Foster, Wil

2003-07-01

The cultural makeup of the United States continues to change rapidly, and as minority groups continue to grow, these groups' beliefs and customs must be taken into account when examining death, grief, and bereavement. This article discusses the beliefs, customs, and rituals of Latino, African American, Navajo, Jewish, and Hindu groups to raise awareness of the differences health care professionals may encounter among their grieving clients. Discussion of this small sample of minority groups in the United States is not intended to cover all of the degrees of acculturation within each group. Cultural groups are not homogeneous, and individual variation must always be considered in situations of death, grief, and bereavement. However, because the customs, rituals, and beliefs of the groups to which they belong affect individuals' experiences of death, grief, and bereavement, health care professionals need to be open to learning about them to better understand and help.

Complicated grief in a two-and-a-half-year-old child.

Science.gov (United States)

Mendhekar, D N; Lohia, D

2010-02-01

The concept of "absence of grief" in children has been embedded in psychoanalytic literature since its beginning. The clinical phenomenon of grief in a toddler is rarely described or analysed in the psychiatric literature. Early theorists felt that grieving does not occur until adolescence due to a younger child's psychological structure, including poor object-relations development. However, data on grief reaction in preschool children has mostly been under-reported or neglected, especially since most of the studies on childhood grief have been conducted on school-age children. We present a two-and-a-half-year-old girl, whose emotional and behavioural reactions to the loss of her grandfather became a focus of clinical attention. This report shows that even toddlers can mourn for their loved ones, although the expression and process of grief differ from that of older children and may occasionally draw clinical attention. Suggestions on how to investigate this phenomenon more closely and how to avoid it in socio-cultural contexts are proposed.

Maintaining connections in children's grief narratives in popular film.

Science.gov (United States)

Sedney, Mary Anne

2002-04-01

Children's grief narratives in popular films were examined for their portrayal of connection-maintaining strategies with the deceased. Comparisons were made between strategies found in actual parentally bereaved children and in child characters in films. Implications of these filmed grief narratives for models of grieving and for practice are discussed.

Mental Pain and Suicide: A Systematic Review of the Literature

OpenAIRE

Verrocchio, Maria Cristina; Carrozzino, Danilo; Marchetti, Daniela; Andreasson, Kate; Fulcheri, Mario; Bech, Per

2016-01-01

Background Mental pain, defined as a subjective experience characterized by perception of strong negative feelings and changes in the self and its function, is no less real than other types of grief. Mental pain has been considered to be a distinct entity from depression. We have performed a systematic review analyzing the relationship between mental pain and suicide by providing a qualitative data synthesis of the studies. Methods We have conducted, in accordance with PRISMA guide...

Grief elaboration in families with handicapped member.

Science.gov (United States)

Calandra, C; Finocchiaro, G; Raciti, L; Alberti, A

1992-01-01

Families with handicapped member seem to follow the same five stages (rejection and isolation, anger, dealing with the problem, depression, acceptance) of Kubler-Ross grief elaboration theory while dealing with the narcissistic wound of a handicapped child. Some of these families show a block in one of the stages. The effort of psychotherapy is to remove the block and let them reach the last stage. In this paper families under systemic psychotherapeutic treatment are analyzed, who had in common the birth of a child with low or modest invalidating signs and psychotic or autistic features. The families structure did not show the characteristics of a psychotic family. Nevertheless either one or both parents ignored the evidence of their child disease and they built a "disease-incongrous" wait around the child, trying to push away the painful reality. The authors explain the importance of this approach for the improvement of the autistic traits.

Behind the smile: qualitative study of caregivers' anguish and management responses while caring for someone living with heart failure.

Science.gov (United States)

Wingham, Jennifer; Frost, Julia; Britten, Nicky

2017-07-20

Caregivers support self-management in heart failure but often experience stress, anxiety and ill health as a result of providing care. 1. To identify the factors that contribute to the experience of anguish.2. To understand how caregivers learn to live with what is frequently a challenging and demanding role. Individual interviews with caregivers who had been caring for someone with heart failure for a minimum of 6 months. We used thematic analysis to inductively analyse transcripts. Twenty-two caregivers, from three centres in the United Kingdom, took part in individual interviews. The caregivers were aged between 39 and 84 years, and six were men. Twenty were in spousal or partner relationships. We found that caregivers often hide the extent of their emotional stress or anguish. We identified four main themes with explanatory subthemes-emotional impact (fear for the future and sense of hopelessness), role definition (changing sense of who I am, reduced resilience, learning care skills, role conflict and changing role), exclusion (exclusion by the cared-for person and by health professionals and feeling alone) and ignoring one's own health-that were associated with anguish. From these findings, we produced a caregiver needs assessment model in the context of caring for a person with heart failure. Caregivers have many unmet and hidden needs. Primary care health professionals are well placed to meet the needs of caregivers. The model may be used by health and social care professionals to identify needs and to provide caregivers with targeted practical and emotional support; and for researchers developing interventions to enhance self-management in heart failure. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Maternal resolution of grief after preterm birth: implications for infant attachment security.

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Shah, Prachi E; Clements, Melissa; Poehlmann, Julie

2011-02-01

This study explored the association between mothers' unresolved grief regarding their infant's preterm birth and infant-mother attachment security. We hypothesized that mothers with unresolved grief would be more likely to have insecurely attached infants at 16 months and that this association would be partially mediated by maternal interaction quality. This longitudinal study focused on 74 preterm infants (age of infants. The present analysis included assessment of neonatal and socioeconomic risks at NICU discharge; maternal depression, Reaction to Preterm Birth Interview findings, and quality of parenting at a postterm age of 9 months; and infant-mother attachment at postterm age of 16 months. Associations among findings of grief resolution with the Reaction to Preterm Birth Interview, quality of parenting interactions, and attachment security were explored by using relative risk ratios and logistic and multivariate regression models. The relative risk of developing insecure attachment when mothers had unresolved grief was 1.59 (95% confidence interval: 1.03-2.44). Controlling for covariates (adjusted odds ratio: 2.94), maternal feelings of resolved grief regarding the preterm birth experience were associated with secure infant-mother attachment at 16 months. Maternal grief resolution and interaction quality were independent predictors of attachment security. Maternal grief resolution regarding the experience of preterm birth and the quality of maternal interactions have important implications for emerging attachment security for infants born prematurely.

Spiritual pain and suffering.

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Brunjes, George B

2010-01-01

Spiritual pain/suffering is commonly experienced by persons with life-limiting illness and their families. Physical pain itself can be exacerbated by non-physical causes such as fear, anxiety, grief, unresolved guilt, depression and unmet spiritual meets. Likewise, the inability to manage physical pain well can be due to emotional and spiritual needs. This is why a holistic, interdisciplinary assessment of pain and suffering is required for each patient and family. The mind, body and spirit are understood in relationship to each other and, in those cases, in relationship to a deity or deities are important to understand. Cultural interpretations of pain and suffering may conflict with the goals of palliative care. Understanding the spiritual framework of the patient and family can help to assure that the physical and spiritual suffering of the patient can be eliminated to provide a peaceful death. Spiritual practices may help in the management of physical pain.

Coping with Death and Grief: A Strategy for Army Leadership

National Research Council Canada - National Science Library

Smith, Albert

1999-01-01

.... The military as a whole is not psychologically prepared to deal with death and grief. Military leaders and soldiers have learned from society that it is not okay to openly express their grief, which has a profound impact on morale in the Army...

A COMPLICATED GRIEF INTERVENTION MODEL

African Journals Online (AJOL)

2010-07-29

Jul 29, 2010 ... of complicated grief as a contributing factor to impaired social functioning. This can ... includes a diagnosis of bereavement-related major depression if symptoms ..... networking, Social Sciences Citation Index, Social Sciences.

End of Life: Suicide Grief

Science.gov (United States)

Healthy Lifestyle End of life A loved one's suicide can be emotionally devastating. Use healthy coping strategies — ... Clinic Staff When a loved one dies by suicide, overwhelming emotions can leave you reeling. Your grief ...

Normal grief and complicated bereavement among traumatized Cambodian refugees: cultural context and the central role of dreams of the dead.

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Hinton, Devon E; Peou, Sonith; Joshi, Siddharth; Nickerson, Angela; Simon, Naomi M

2013-09-01

This article profiles bereavement among traumatized Cambodian refugees and explores the validity of a model of how grief and post-traumatic stress disorder (PTSD) interact in this group to form a unique bereavement ontology, a model in which dreams of the dead play a crucial role. Several studies were conducted at a psychiatric clinic treating Cambodian refugees who survived the Pol Pot genocide. Key findings included that Pol Pot deaths were made even more deeply disturbing owing to cultural ideas about "bad death" and the consequences of not performing mortuary rites; that pained recall of the dead in the last month was common (76 % of patients) and usually caused great emotional and somatic distress; that severity of pained recall of the dead was strongly associated with PTSD severity (r = .62); that pained recall was very often triggered by dreaming about the dead, usually of someone who died in the Pol Pot period; and that Cambodians have a complex system of interpretation of dreams of the deceased that frequently causes those dreams to give rise to great distress. Cases are provided that further illustrate the centrality of dreams of the dead in the Cambodian experiencing of grief and PTSD. The article shows that not assessing dreams and concerns about the spiritual status of the deceased in the evaluation of bereavement results in "category truncation," i.e., a lack of content validity, a form of category fallacy.

DESCRIPCIÓN DEL PROCESO DE DUELO EN MILITARES VÍCTIMAS DE MINAS ANTIPERSONA -- DESCRIPTION OF GRIEF PROCESS IN MILITARY VICTIMS OF ANTI-PERSONNEL MINES

Directory of Open Access Journals (Sweden)

PAULO DANIEL ACERO RODRÍGUEZ

2008-06-01

Full Text Available The conflict of which is setting Colombia, has brought with himself the utilization of anti-perssonel mines which the groups use to protect their territories of influence and in the moments in which they are pursued for the public force. This paper shows the results obtained from the investigation realised by the authors with a group of the military who key in minefields thus took place amputations, the central objectives were to describe the grief process that these people by the lost one of members of their body confront and to explore on the elements that affect the facing of the traumatic event. A qualitative methodology was used, interviewing to 8 members of Colombian army affected by mines person. The results allow to observe two classes of psychological mechanisms of facing: the mechanisms of defense before the originating anguish of the hostility of external means, (negation, minimisation regression, rationalization, repression and isolation which make its appearance at the first the psychological moments of the explosive impact and mechanisms that help the amputee to adapt to their new condition, (comparison, atemporality, importance and spirituality which they appear at a second moment when the amputation is realised under surgical conditions and therefore already is perceived like a measurement for the preservation of the life.

Grief Counselling In African Indigenous Churches: A Case Of The ...

African Journals Online (AJOL)

collective participation, social isolation of the bereaved and then culminates in reincorporation of the bereaved into the community. The aim of this article is to explicate the meaning and value of grief counselling in AICs with special reference to the Zion Apostolic Church in Venda. Keywords: Grief counselling, african ...

The impact of bereaved parents' perceived grief similarity on relationship satisfaction

NARCIS (Netherlands)

Buyukcan-Tetik, Asuman; Finkenauer, Catrin; Schut, Henk; Stroebe, Margaret; Stroebe, Wolfgang

2017-01-01

The present research focused on bereaved parents' perceived grief similarity, and aimed to investigate the concurrent and longitudinal effects of the perceptions that the partner has less, equal, or more grief intensity than oneself on relationship satisfaction. Participants of our longitudinal

The Impact of Bereaved Parents' Perceived Grief Similarity on Relationship Satisfaction

NARCIS (Netherlands)

Buyukcan-Tetik, Asuman; Finkenauer, Catrin; Schut, Henk; Stroebe, Margaret; Stroebe, Wolfgang

The present research focused on bereaved parents' perceived grief similarity, and aimed to investigate the concurrent and longitudinal effects of the perceptions that the partner has less, equal, or more grief intensity than oneself on relationship satisfaction. Participants of our longitudinal

Exploring oncology nurses' grief: A self-study

Directory of Open Access Journals (Sweden)

Lisa C Barbour

2016-01-01

Full Text Available Oncology nursing, like many other nursing fields, often provides nurses with the opportunity to get to know their patients and their families well. This familiarity allows oncology nurses to show a level of compassion and empathy that is often helpful to the patient and their family during their struggle with cancer. However, this familiarity can also lead to a profound sense of grief if the patient loses that struggle. This self-study provided me the opportunity to systematically explore my own experience with grief as an oncology nurse, helping me to identify specific stressors and also sources of stress release.

Cognitive-Behavioral Grief Therapy: The ABC Model of Rational-Emotion Behavior Therapy

Directory of Open Access Journals (Sweden)

Ruth Malkinson

2010-12-01

Full Text Available The article briefly reviews the changes that occurred in the field of grief and bereavement, viewing it as a process of searching for a "rational" meaning to life without the deceased in line with the concept of continuing bonds and thus replacing that of Fred’s concept of decathexis. Cognitive-behavioral therapy (CBT evidenced-based studies for PTSD and complicated grief and the Cognitive-behavioral therapy − Rational-emotion behavior therapy (CBT-REBT model for grief are reviewed. The focus of intervention based on CBT-REBT is to facilitate a healthy adaptation to loss following death. A distinction is made between rational (adaptive and irrational (maladaptive grief processes. Case example illustrating the application of the model specifically a dialogue with repetitive thoughts, are presented.

Practical approaches to spiritual pain.

Science.gov (United States)

Brunjes, George B

2010-01-01

Spiritual pain/suffering is commonly experienced by persons with life-limiting illness and their families. Physical pain itself can be exacerbated by non-physical causes such as fear, anxiety, grief, unresolved guilt, depression and unmet spiritual meets. Likewise, the inability to manage physical pain well can be due to emotional and spiritual needs. This is why a holistic, interdisciplinary assessment of pain and suffering is required for each patient and family. The mind, body and spirit are understood in relationship to each other and, in those cases, in relationship to a deity or deities are important to understand. Cultural interpretations of pain and suffering may conflict with the goals of palliative care. Understanding the spiritual framework of the patient and family can help to assure that the physical and spiritual suffering of the patient can be eliminated to provide a peaceful death. Spiritual practices may help in the management of physical pain.

A COMPLICATED GRIEF INTERVENTION MODEL

African Journals Online (AJOL)

2010-07-29

Jul 29, 2010 ... work approach to therapy) in an attempt to develop a model for complicated grief intervention ..... way feels right for them, thus making them equal partners with .... This question points out the benefits of success and affords the.

A COMPLICATED GRIEF INTERVENTION MODEL

African Journals Online (AJOL)

2010-07-29

Jul 29, 2010 ... 2006). Grief thus refers to the physical, emotional, cognitive, spiritual and social experiences of the loss. ... (CGIM) will add to a better understanding of the client and that it will also ... MOTIVATION FOR THE STUDY. There are ...

Perinatal grief following a termination of pregnancy for foetal abnormality: the impact of coping strategies.

Science.gov (United States)

Lafarge, Caroline; Mitchell, Kathryn; Fox, Pauline

2013-12-01

Pregnancy termination for foetal abnormality (TFA) can have significant psychological repercussions, but little is known about the coping strategies involved in dealing with TFA. This study examined the relationships between women's coping strategies and perinatal grief. A total of 166 women completed a survey online. Coping and perinatal grief were measured using the Brief COPE and Short Perinatal Grief Scales. Data were analysed through multiple regression analyses. Despite using mostly adaptive coping strategies, women's levels of grief were high and varied according to obstetric and termination variables. Grief was predicted by behavioural disengagement, venting, planning, religion, self-blame, being recently bereaved, being childless at the time of TFA, not having had children/being pregnant since TFA and uncertainty about the decision to terminate the pregnancy. Acceptance and positive reframing negatively predicted grief. Identifying women vulnerable to poor psychological adjustment and promoting coping strategies associated with lower levels of grief may be beneficial. This could be addressed through information provision and interventions such as Cognitive Behavioural Therapy or Acceptance and Commitment Therapy. © 2013 John Wiley & Sons, Ltd.

The ties that bind: a reflection on physician grief.

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Giddings, Gordon

2010-10-01

Physician grief remains a prevalent yet largely unacknowledged problem in the medical profession. Several techniques can be employed to improve coping in physicians that deal frequently with patients approaching the end of life that can be integrated into medical training programs and physician practices. The author recounts his own experience of physician grief having cared for a patient on his dying journey and using it as an opportunity for personal growth.

Cognitive-Behavioral Grief Therapy: The ABC Model of Rational-Emotion Behavior Therapy

OpenAIRE

Malkinson, Ruth

2010-01-01

The article briefly reviews the changes that occurred in the field of grief and bereavement, viewing it as a process of searching for a "rational" meaning to life without the deceased in line with the concept of continuing bonds and thus replacing that of Fred’s concept of decathexis. Cognitive-behavioral therapy (CBT) evidenced-based studies for PTSD and complicated grief and the Cognitive-behavioral therapy − Rational-emotion behavior therapy (CBT-REBT) model for grief are reviewed. The foc...

Resolving Child and Adolescent Traumatic Grief: Creative Techniques and Interventions

Science.gov (United States)

Edgar-Bailey, Meredith; Kress, Victoria E.

2010-01-01

This article presents a review of creative interventions that can be helpful in facilitating the resolution of traumatic grief in children and adolescents. Traumatic grief is conceptualized as a condition in which a person loses a close loved one (e.g., a parent or a sibling) in a traumatic manner, and ensuing trauma-related symptoms disrupt the…

Social and cultural factors associated with perinatal grief in Chhattisgarh, India.

Science.gov (United States)

Roberts, Lisa R; Montgomery, Susanne; Lee, Jerry W; Anderson, Barbara A

2012-06-01

Stillbirth is a globally significant public health problem with many medical causes. There are also indirect causal pathways including social and cultural factors which are particularly salient in India's traditional society. The purpose of this study was to explore women's perceptions of stillbirth and to determine how issues of gender and power, social support, coping efforts, and religious beliefs influence perinatal grief outcomes among poor women in rural Chhattisgarh, India. Structured interviews were done face-to-face in 21 randomly selected villages among women of reproductive age (N=355) who had experienced stillbirth (n=178) and compared to those who had not (n=177), in the Christian Hospital, Mungeli catchment area. Perinatal grief was significantly higher among women with a history of stillbirth. Greater perinatal grief was associated with lack of support, maternal agreement with social norms, and younger maternal age. These predictors must be understood in light of an additional finding-distorted sex ratios, which reflect gender discrimination in the context of Indian society. The findings of this study will allow the development of a culturally appropriate health education program which should be designed to increase social support and address social norms, thereby reducing psychological distress to prevent complicated perinatal grief. Perinatal grief is a significant social burden which impacts the health women.

Grief: Lessons from the Past, Visions for the Future

Directory of Open Access Journals (Sweden)

Colin Murray Parkes

2010-09-01

Full Text Available Over the last millennium patterns of mortality have changed and have determined who grieves and how. At all times grief has been recognised as a threat to physical and mental health. More recently the scientific study of bereavement has enabled us to quantify such effects and to develop theoretical explanations for them. This paper reviews our evolving understanding of grief, focusing especially on the developments in research, theory and practice that have taken place during the twentieth century. Wars and similar conflicts are associated with repression of grief but methods of helping by facilitating its expression, which were introduced during the two World Wars are less needed and effective at other times. In recent years more attention has been paid to the social context in which grief arises and, particularly, to the nature of the attachments which precede and influence the reaction to bereavement and to other traumatic life events. At the same time a range of caring resources have become available and acceptable to bereaved people and the results of scientific evaluation of these give promise that we are moving towards an era in which more sensitive and appropriate care will be provided to the bereaved by both voluntary and professional caregivers.

Adult Children of Dysfunctional Families: Treatment from a Disenfranchised Grief Perspective.

Science.gov (United States)

Zupanick, Corinne E.

1994-01-01

Generalizes concept of disenfranchised grief to understanding of recovery process for adult children of dysfunctional families. Describes recovery process of this population as parallel to grief process. Identifies two layers of unrecognized loss: loss of one's childhood and loss of one's fantasized and idealized parent. Suggests specific…

Grief: The Unrecognized Parental Response to Mental Illness in a Child.

Science.gov (United States)

MacGregor, Peggy

1994-01-01

Notes that parents whose son or daughter develops serious mental illness experience grief that is often neither recognized by society nor addressed by mental health professionals. Describes some common elements of parental bereavement, losses experienced with mental illness, consequences of ignoring grief, and appropriate interventions for mental…

Predicting Grief Reactions One Year Following a Mass University Shooting: Evaluating Dose-Response and Contextual Predictors.

Science.gov (United States)

Smith, Andrew J; Layne, Christopher M; Coyle, Patrick; Kaplow, Julie B; Brymer, Melissa J; Pynoos, Robert S; Jones, Russell T

2017-12-01

This study identifies risk factors for grief following a mass school shooting. Participants (N = 1,013) completed online questionnaires 3-4 months (Time 1) and 1 year (Time 2) post-shootings. We tested models predicting Time 2 grief reactions, exploring direct and indirect predictive effects of exposure variables (physical and social proximity) through hypothesized peritraumatic mediators (peritraumatic perceived threat to self or others) while controlling for Time 1 grief and posttraumatic stress (PTS) reactions, pretrauma vulnerabilities. Findings demonstrate that closer social proximity predicted higher levels of Time 2 grief, directly and indirectly through increasing peritraumatic perceived threat to others' safety. Physical proximity and peritraumatic threat to self did not predict Time 2 grief reactions. Implications for grief screening instruments and theory building research through identifying risk factors and causal mechanisms are discussed.

Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG): toward integrated treatment of symptoms related to traumatic loss.

Science.gov (United States)

Smid, Geert E; Kleber, Rolf J; de la Rie, Simone M; Bos, Jannetta B A; Gersons, Berthold P R; Boelen, Paul A

2015-01-01

Traumatic events such as disasters, accidents, war, or criminal violence are often accompanied by the loss of loved ones, and may then give rise to traumatic grief. Traumatic grief refers to a clinical diagnosis of persistent complex bereavement disorder (PCBD) with comorbid (symptoms of) posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD) following confrontation with a traumatic loss. Trauma survivors, who are frequently from different cultural backgrounds, have often experienced multiple losses and ambiguous loss (missing family members or friends). Current evidence-based treatments for PTSD do not focus on traumatic grief. To develop a treatment for traumatic grief combining treatment interventions for PTSD and PCBD that may accommodate cultural aspects of grief. To provide a rationale for treatment, we propose a cognitive stress model of traumatic grief. Based on this model and on existing evidence-based treatments for PTSD and complicated grief, we developed Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG) for the treatment of patients with traumatic grief. The treatment is presented along with a case vignette. Processes contributing to traumatic grief include inadequately integrating the memory of the traumatic loss, negative appraisal of the traumatic loss, sensitivity to matching triggers and new stressors, and attempting to avoid distress. BEP-TG targets these processes. The BEP-TG protocol consists of five parts with proven effectiveness in the treatment of PCBD, PTSD, and MDD: information and motivation, grief-focused exposure, memorabilia and writing assignments, finding meaning and activation, and a farewell ritual. Tailored to fit the needs of trauma survivors, BEP-TG can be used to address traumatic grief symptoms related to multiple losses and ambiguous loss, as well as cultural aspects of bereavement through its different components.

Are shame and self-esteem risk factors in prolonged grief after death of a spouse?

Science.gov (United States)

Dellmann, Thomas

2018-07-01

Although many single factors of prolonged grief have been identified in the literature, a comprehensive understanding of predictors is still lacking. This article argues that shame and low self-esteem, present risk factors in prolonged grief after spousal loss, based on a review of correlational studies. Using a practitioner-scientist approach, a developmental model of shame as a core factor in prolonged grief is proposed, outlining the progression from childhood relational trauma, to insecure attachment, shame, self-esteem contingent on spousal approval to eventual prolonged grief.

Staff Grief Resolution and Care for the Elderly: Artificial Intelligence Analysis.

Science.gov (United States)

Seibert, Phyllis M.; Pastorello, Thomas

Literature on health professionals describes the problems associated with unresolved or poorly resolved grief. Previous research has indicated that the most important reason why health professionals stay in their jobs is their relationship to patients. This study examined how nursing home personnel resolve their grief following deaths of clients.…

Back home: a qualitative study exploring re-entering cross-cultural missionary aid workers' loss and grief.

Science.gov (United States)

Selby, Susan; Moulding, Nicole; Clark, Sheila; Jones, Alison; Braunack-Mayer, Annette; Beilby, Justin

2009-01-01

Over 200 Australian, American, and British Non-Government Organizations send aid workers overseas including missionaries. On re-entry, they may suffer psychological distress; however, there is little research about their psychosocial issues and management in the family practice setting. Research suggests loss and grief as a suitable paradigm for family practitioners dealing with psychosocial issues. The aim of this study was to explore loss and grief issues for adult Australian missionary cross-cultural aid workers during their re-entry adjustment. Mixed methods were used and this study reports the qualitative method: semi-structured interviews conducted with 15 participants. Results were analyzed using framework analysis. Themes of re-entry loss and grief were identified with sub-themes of multiple varied losses, mechanisms of loss, loss of control, common grief phenomena, disenfranchised grief, and reactivation of past grief. Theoretical and clinical implications are discussed. Findings of this study suggest that loss and grief is an appropriate paradigm for the management of these workers in the family practice setting. Further research is needed to enable appropriate care.

A Nationwide Random Sampling Survey of Potential Complicated Grief in Japan

Science.gov (United States)

Mizuno, Yasunao; Kishimoto, Junji; Asukai, Nozomu

2012-01-01

To investigate the prevalence of significant loss, potential complicated grief (CG), and its contributing factors, we conducted a nationwide random sampling survey of Japanese adults aged 18 or older (N = 1,343) using a self-rating Japanese-language version of the Complicated Grief Brief Screen. Among them, 37.0% experienced their most significant…

A systematic writing program as a tool in the grief process: part 1.

Science.gov (United States)

Furnes, Bodil; Dysvik, Elin

2010-12-06

The basic aim of this paper is to suggest a flexible and individualized writing program as a tool for use during the grief process of bereaved adults. An open, qualitative approach following distinct steps was taken to gain a broad perspective on the grief and writing processes, as a platform for the writing program. Following several systematic methodological steps, we arrived at suggestions for the initiation of a writing program and its structure and substance, with appropriate guidelines. We believe that open and expressive writing, including free writing and focused writing, may have beneficial effects on a person experiencing grief. These writing forms may be undertaken and systematized through a writing program, with participation in a grief writing group and with diary writing, to achieve optimal results. A structured writing program might be helpful in promoting thought activities and as a tool to increase the coherence and understanding of individuals in the grief process. Our suggested program may also be a valuable guide to future program development and research.

General Psychological Implications of the Human Capacity for Grief.

Science.gov (United States)

Brinkmann, Svend

2018-06-01

Much theorizing in psychology and related disciplines begins with a given model of the mind that is then applied in research projects to study concrete phenomena. Sometimes psychological research can be theory-driven in quite an explicit way, approaching the logic of the hypothetico-deductive method. Others reject this and prefer to work inductively, and, in the extreme case of positivism, perhaps try to avoid theorizing altogether. In this article I shall suggest another way to think of the relationship between psychological theories and psychological phenomena. My suggestion is not simply to replace the hypothetico-deductive model with an inductive one, but to argue that the most direct route to theories of the human mind that grasp its complexity is to begin with the Kantian question of transcendental philosophy: X exists - how is X possible? In the context of this article, I apply this questioning to the phenomenon of grief: Grief exists - what general psychological theory of the mind do we need in order to account for its possibility? I attempt to extract three general psychological points from the existence of grief, viz. (1) the deep relationality of the self, (2) the limitations of evolutionary accounts, and (3) the normativity of psychological phenomena. I shall argue that these are general psychological lessons to be learned from grief, although they could also be arrived at by considering several other significant psychological phenomena.

Coping with Grief: Life After Loss

Science.gov (United States)

... are called grief. It’s a natural response to loss. Grieving doesn’t mean that you have to feel certain emotions. People can grieve in very different ways. Cultural beliefs and traditions can influence how someone expresses ...

After the death of a friend: young men's grief and masculine identities.

Science.gov (United States)

Creighton, Genevieve; Oliffe, John L; Butterwick, Shauna; Saewyc, Elizabeth

2013-05-01

Young men can have an uncomfortable relationship with grief. Socially constructed masculine ideals dictate that men be stoic in the aftermath of loss, most often expressing their sadness and despair as anger. Perhaps because of alignment to such masculine ideals little research has been done to explore young men's grief--and chronicle the ways they think about loss, their responses and how they go about describing their identities after a tragic event. Using qualitative individual interviews and photo elicitation methods, we investigated the ways in which 25 men aged 19-25 grieved the accidental death of a male friend. The study was conducted from April 2010-December 2011. Causes of death were diverse, and included motor vehicle accidents, adventure sports, drug overdose and fights. The findings revealed men's predominant grief responses as emptiness, anger, stoicism and sentimentality. Participants' description of their grief responses illustrated the ways in which they struggled to reconcile feelings of vulnerability and manly ideals of strength and stoicism. We gained insight into men's grief practices by looking at the ways in which they aligned themselves with a post-loss masculine identity. These identities, which included the adventurer, father-figure and the lamplighter, revealed gender-specific processes through which men understood and actively dealt with their tragic loss. The results offer novel insights to men's grief and identity work that may serve to affirm other men's experiences as well as guide counselling services targeted to young men. Copyright © 2013 Elsevier Ltd. All rights reserved.

Grief Symptoms in Relatives who Experienced Organ Donation Request in the ICU.

Science.gov (United States)

Kentish-Barnes, Nancy; Chevret, Sylvie; Cheisson, Gaëlle; Joseph, Liliane; Martin-Lefèvre, Laurent; Si Larbi, Anne Gaelle; Viquesnel, Gérald; Marqué, Sophie; Donati, Stéphane; Charpentier, Julien; Pichon, Nicolas; Zuber, Benjamin; Lesieur, Olivier; Ouendo, Martial; Renault, Anne; Le Maguet, Pascale; Kandelman, Stanislas; Thuong, Marie; Floccard, Bernard; Mezher, Chaouki; Galon, Marion; Duranteau, Jacques; Azoulay, Elie

2018-03-19

In the case of organ donation, the family is highly involved in the decision process. To assess experience of organ donation process and grief symptoms in relatives of brain dead patients who discussed organ donation in the ICU. Multicentre cross-sectional study in 28 ICUs in France. Participating subjects were relatives of brain dead patients who were approached to discuss organ donation. Relatives were followed-up by phone at 3 time points: at 1 month to complete a questionnaire describing their experience of organ donation process; At 3 months to complete the Hospital Anxiety and Depression Scale and the Impact of Event Scale-Revised; At 9 months, to complete the IES-R and the Inventory of Complicated Grief. 202 relatives of 202 patients were included, of whom 158 consented and 44 refused organ donation. Interviews were conducted at 1, 3 and 9 months for 157, 137 and 117 relatives respectively. Experience was significantly more burdensome for relatives of non-donors. However there were no significant differences in grief symptoms measured at 3 and 9 months between the 2 groups. Understanding of brain death was associated with grief symptoms with higher prevalence of complicated grief symptoms in relatives who did not understand (75% vs 46.1%, p=0.026). Experience of the organ donation process varies between relatives of donor vs non-donor patients with relatives of non-donors experiencing lower quality communication, but the decision was not associated with subsequent grief symptoms. Importantly, understanding of brain death is a key element for relatives.

Accommodating Grief on Twitter: An Analysis of Expressions of Grief Among Gang Involved Youth on Twitter Using Qualitative Analysis and Natural Language Processing

Science.gov (United States)

Patton, Desmond Upton; MacBeth, Jamie; Schoenebeck, Sarita; Shear, Katherine; McKeown, Kathleen

2018-01-01

There is a dearth of research investigating youths’ experience of grief and mourning after the death of close friends or family. Even less research has explored the question of how youth use social media sites to engage in the grieving process. This study employs qualitative analysis and natural language processing to examine tweets that follow 2 deaths. First, we conducted a close textual read on a sample of tweets by Gakirah Barnes, a gang-involved teenaged girl in Chicago, and members of her Twitter network, over a 19-day period in 2014 during which 2 significant deaths occurred: that of Raason “Lil B” Shaw and Gakirah’s own death. We leverage the grief literature to understand the way Gakirah and her peers express thoughts, feelings, and behaviors at the time of these deaths. We also present and explain the rich and complex style of online communication among gang-involved youth, one that has been overlooked in prior research. Next, we overview the natural language processing output for expressions of loss and grief in our data set based on qualitative findings and present an error analysis on its output for grief. We conclude with a call for interdisciplinary research that analyzes online and offline behaviors to help understand physical and emotional violence and other problematic behaviors prevalent among marginalized communities. PMID:29636619

Creating philanthropic foundations to deal with grief: case studies of bereaved parents.

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Rossetto, Kelly R

2014-01-01

The current study involves the analysis of six bereaved parents' stories and argues that the development of philanthropic foundations helped these parents make meaning of their children's deaths and find purpose in the midst of their grief. Furthermore, philanthropy, as a way of making meaning and finding purpose, is a mutually beneficial process because it helps both the bereaved founders and the communities the organizations reach. Connections between these narratives and the bereavement literature help us better understand the individual/family grief process and meaning making, as well as how internal grief states intersect with communities.

42 CFR 488.301 - Definitions.

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2010-10-01

... the resident's consent. Neglect means failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness. Noncompliance means any deficiency that causes a facility... confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Deficiency...

A angústia, o nada e a morte em Heidegger Anguish, nothingness and death in Heidegger

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Marco Aurélio Werle

2003-01-01

Full Text Available O artigo investiga a relação entre os conceitos de medo, angústia, nada e morte na filosofia da existência de Heidegger. Pretende-se apontar para o papel destes fenômenos existenciais na passagem do ser-aí desde a inautenticidade para a autenticidade de seu ser.This paper investigates the relationship between the concepts of fear, anguish, nothingness and death in Heidegger's philosophy of existence. It points to the role of these existential phenomena in the transformation of "Dasein", from the inauthenticity to the authenticity of its Being.

Cultural manifestations of grief and bereavement: a clinical perspective.

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Hardy-Bougere, Marilyn

2008-01-01

The purpose of this article is to inform the reader that a commonality in grief and bereavement exists even though it is highly individualized. Health care providers and consumers of health care should realize and understand the potential for bias and miscommunication when there is delivery of care from non-similar cultures. Grief and bereavement are two of many issues existing in the health care delivery system which can result in substandard delivery of care as a result of cultural insensitivity and cultural incompetence.

Graduate students' self assessment of competency in grief education and training in core accredited rehabilitation counseling programs

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Cicchetti, Richard Jude

The study examined whether 93 master's level rehabilitation counselor trainees from select Midwestern CORE-accredited schools report having been adequately trained to identify and work with clients who are having grief-related issues from a loss or disability. Using the Grief Counseling Competency Scale (GCCS), participants showed a wide range of scores regarding personal competency related to grief; however, scores tended to be low when examining skills and knowledge relating to grief, with most respondents scoring between "this barely describes me" and "this somewhat describes me." Although presence or history of a disability was found to be related to personal competency, a number of variables were not related, including: gender, age, race/ethnicity, course work in grief theories and grief interventions, practica/internship setting, and attitudes toward people with disabilities. Implications for further research are discussed.

Grief after patient death: direct care staff in nursing homes and homecare.

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Boerner, Kathrin; Burack, Orah R; Jopp, Daniela S; Mock, Steven E

2015-02-01

Patient death is common in long-term care (LTC). Yet, little attention has been paid to how direct care staff members, who provide the bulk of daily LTC, experience patient death and to what extent they are prepared for this experience. To 1) determine how grief symptoms typically reported by bereaved family caregivers are experienced among direct care staff, 2) explore how prepared the staff members were for the death of their patients, and 3) identify characteristics associated with their grief. This was a cross-sectional study of direct care staff experiencing recent patient death. Participants were 140 certified nursing assistants and 80 homecare workers. Standardized assessments and structured questions addressed staff (e.g., preparedness for death), institutional (e.g., support availability), and patient/relational factors (e.g., relationship quality). Data analyses included bivariate group comparisons and hierarchical regression. Grief reactions of staff reflected many of the core grief symptoms reported by bereaved family caregivers in a large-scale caregiving study. Feelings of being "not at all prepared" for the death and struggling with "acceptance of death" were prevalent among the staff. Grief was more intense when staff-patient relationships were closer, care was provided for longer, and staff felt emotionally unprepared for the death. Grief symptoms like those experienced by family caregivers are common among direct care workers after patient death. Increasing preparedness for this experience via better training and support is likely to improve the occupational experience of direct care workers and ultimately allow them to provide better palliative care in nursing homes and homecare. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Dream Content in Complicated Grief: A Window into Loss-Related Cognitive Schemas Running Head: Dreams in Complicated Grief

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Germain, Anne; Shear, Katherine M.; Walsh, Colleen; Buysse, Daniel J.; Monk, Timothy H.; Reynolds, Charles F.; Frank, Ellen; Silowash, Russell

2012-01-01

Bereavement and its accompanying psychological response (grief) constitute potent experiences that necessitate the reorganization of cognitive-affective representations of lost significant attachment figures during both wakefulness and dreaming. The goals of this preliminary study were to explore whether the dream content of 77 adults with complicated grief (CG) differed from that of a normative sample, and to explore whether CG patients who dream of the deceased differ from CG patients who do not dream of the deceased on measures of daytime emotional distress. CG dreams were characterized by more family and familiar characters including the deceased (in women), and fewer social interactions and emotions compared to norms. Increased representations of familiar characters in CG dreams may reflect attempts to reorganize relational cognitive schemas to compensate for the loss. PMID:24524436

The year of magical thinking: Joan Didion and the dialectic of grief.

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Brennan, F; Dash, M

2008-06-01

Joan Didion is a prominent American writer. In late 2003, while her only child lay critically ill, her husband, John, died suddenly. Theirs was a marriage of great intimacy and love. Grief enveloped her. Eventually she began to write an account of the first 12 months of her bereavement and the vigil for her child: The year of magical thinking. Raw, insightful and challenging, it is a rich, generous and graceful document. Didion draws on the literature of grief, personal and professional. Here, those readings are examined and reflections are made on the singular, unique grief of the author in the context of current theories on bereavement.

Grief and Solidarity Reactions 1 Week After an On-Campus Shooting.

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Wayment, Heidi A; Silver, Roxane Cohen

2018-03-01

The impact of interpersonal violence extends beyond the victims and perpetrator(s). The purpose of this research was threefold: (a) to identify whether college students' very early reactions to an on-campus shooting were associated with well-known predictors of distress, (b) to examine whether grief and distress reactions were distinguishable in the early days following a shooting, and (c) to investigate whether a compassionate self-identity was uniquely associated with grief but not distress. Beginning just 3 days after an early morning shooting that killed one student and injured three others, university students ( N = 408) completed an online questionnaire. Grief, but not distress, was associated with a sense of solidarity with other students and a compassionate self-identity. General distress was associated with prior mental health difficulties and exposure to the shooting. Acute stress was positively associated with being female, having prior mental health difficulties, media exposure, perceived similarity to victims, less victim blame, social support, and social strain. Results suggest that grief reactions that arise in the early days following a collective loss may serve as important psychosocial resources in coping with interpersonal violence.

[A Clinical Case of Grief Hallucination through the Mourning Work Normal Grief and Spiritual Care].

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Kurotori, Isaku; Kato, Satoshi

2015-01-01

Auditory or visual hallucinations of a deceased person are well known in the normal course of the bereavement process. According to DSM-5, this symptom is included in the associated features supporting diagnosis of persistent complex bereavement disorder. In Japan, however, little is known about these hallucinatory experiences during grieving, and few reports on their prevalence are available. Here, we have reported a clinical case of such experiences following the loss of a spouse. A 66-year-old patient presented to the outpatient department with insomnia after her husband's death. She was preoccupied with a sense of loss and absolute loneliness. One day, she confessed to regularly encountering her husband's ghost at night; the ghost was distinguishable from a dream and provided the bereaved wife with some degree of comfort. The appearances lasted for 15 months and occurred several times a week without disturbing her social functioning. She gradually became aware that her husband was returning from the spirit world to give her solace. Her treatment was focused on resolving her conflicting feelings concerning her grief at his death and her relief at his no longer suffering from disease. While accepting her experiences, she started to review the days they spent together and appreciated his attachment. Therefore she completed the work of mourning and the ghost no longer appeared. One year after the departure of the ghost, she still attends the hospital regularly and there has been no recurrence. A reconstruction of her internal world leads us to conclude that the support of normal grief with such hallucinations prevents the intense experience of loss from generating pathological grief. Furthermore, we suggest reconsidering the importance of the mourning work and the inclusion of both the bereaved and deceased person in the medical context.

Factors associated with the grief after stillbirth: a comparative study between Brazilian and Canadian women

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Gisele Ferreira Paris

Full Text Available Abstract OBJECTIVE To verify the association between complicated grief and sociodemographic, reproductive, mental, marital satisfaction, and professional support characteristics in women after stillbirth. METHOD Cross-sectional study with 26 women who had stillbirth in 2013, living in the city of Maringá, Brazil, and eight women who attended the Centre d'Études et de Rechercheen Intervention Familiale at the University of Quebec en Outaouais, in Canada. The instrument was administered as an interview to a small number of mothers of infants up to three months (n=50, who did not participate in the validation study. RESULTS By applying the short version of the Perinatal Grief Scale, the prevalence of complicated grief in Brazilian women was found to be higher (35% in relation to Canadian women (12%.Characteristics of the Brazilian women associated with the grief period included the presence of previous pregnancy with live birth, absence of previous perinatal loss, postpartum depression, and lack of marital satisfaction. For the Canadians it was observed that 80% of the women presenting no grief made use of the professional support group. In both populations the occurrence of complicated grief presented a higher prevalence in women with duration of pregnancy higher than 28 weeks. CONCLUSION The women that must be further investigated during the grief period are those living in Brazil, making no use of a professional support group, presenting little to no marital satisfaction, having no religion, and of a low educational level.

Dyadic coping mediates the relationship between parents' grief and dyadic adjustment following the loss of a child.

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Albuquerque, Sara; Narciso, Isabel; Pereira, Marco

2018-01-01

This study aimed to examine forms of dyadic coping (DC) as mediators of the association between parents' grief response and dyadic adjustment and to determine whether these indirect effects were moderated by the child's type of death, timing of death, and age. The study design was cross-sectional. The sample consisted of 197 bereaved parents. Participants completed the Prolonged Grief Disorder Scale, Revised Dyadic Adjustment Scale, and Dyadic Coping Inventory. Significant indirect effects of parents' grief response on dyadic adjustment were found through stress communication by oneself and by the partner, positive and negative DC by the partner, and joint DC. The timing of death moderated the association between grief response and dyadic adjustment and between joint DC and dyadic adjustment. Grief response was negatively associated with dyadic adjustment only when the death occurred after birth. Grief response was negatively associated with joint DC, which, in turn, was positively associated with dyadic adjustment, when the death occurred both before and after birth. However, the association was stronger in the latter. Specific forms of DC might be mechanisms through which grief response is associated with dyadic adjustment and should be promoted in clinical practice.

After the death of a friend: Young Men’s grief and masculine identities

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Creighton, Genevieve; Oliffe, John L.; Butterwick, Shauna; Saewyc, Elizabeth

2015-01-01

Young men can have an uncomfortable relationship with grief. Socially constructed masculine ideals dictate that men be stoic in the aftermath of loss, most often expressing their sadness and despair as anger. Perhaps because of alignment to such masculine ideals little research has been done to explore young men’s grief – and chronicle the ways they think about loss, their responses and how they go about describing their identities after a tragic event. Using qualitative individual interviews and photo elicitation methods, we investigated the ways in which 25 men aged 19–25 grieved the accidental death of a male friend. The study was conducted from April 2010–December 2011. Causes of death were diverse, and included motor vehicle accidents, adventure sports, drug overdose and fights. The findings revealed men’s predominant grief responses as emptiness, anger, stoicism and sentimentality. Participants’ description of their grief responses illustrated the ways in which they struggled to reconcile feelings of vulnerability and manly ideals of strength and stoicism. We gained insight into men’s grief practices by looking at the ways in which they aligned themselves with a post-loss masculine identity. These identities, which included the adventurer, father-figure and the lamplighter, revealed gender-specific processes through which men understood and actively dealt with their tragic loss. The results offer novel insights to men’s grief and identity work that may serve to affirm other men’s experiences as well as guide counselling services targeted to young men. PMID:23517702

Normal grief and its correlates in Lubumbashi, an urban city in the ...

African Journals Online (AJOL)

Introduction: grief is a universal experience faced at one time or another by most people during their lives. Response to grief and bereavement losses can lead to psychiatric disorders such as mood disorders, post traumatic responses, insomnia loss of appetite, anxiety, and depression. The aim of our study is to value in our ...

Complicated grief and bereavement in young adults following close friend and sibling loss.

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Herberman Mash, Holly B; Fullerton, Carol S; Ursano, Robert J

2013-12-01

This study examined the association between types of loss (i.e., sibling or close friend) and relationship quality (i.e., depth and conflict) with complicated grief, depression, somatic symptoms, and world assumptions in bereaved young adults. Participants were 107 young adults aged 17-29 years who were either bereaved or had never experienced a loss. Among bereaved participants, 66 lost a close friend and seven lost a sibling within the past 3 years (M = 1.63 years). Nineteen percent of the young adults met criteria for complicated grief and 31% had mild to severe depression. Participants with a deceased sibling reported greater depth in the relationship as compared to those who lost a friend. They were also more likely to have complicated grief (57% versus 15%) and report significantly higher levels of grief, depression, and somatic symptoms. Those who lost a sibling reported a lower sense of meaningfulness and benevolence of the world and self-worth as compared with those who lost a close friend or had not experienced a loss. Complicated grief and depression are common among bereaved young adults. Sibling loss is particularly distressing to young adults, due in part to the high level of relationship depth, and is associated with increased psychological and physical symptoms postloss. © 2013 Wiley Periodicals, Inc.

Providing grief resolution as an oncology nurse retention strategy: a literature review.

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Hildebrandt, Lori

2012-12-01

Oncology nurses play a pivotal role in optimizing care provided to patients at the end of life (EOL). Although oncology nurses commonly provide EOL care and witness deaths of patients that they have maintained long-standing relationships with, they are frequently excluded from grief resolution endeavors. With a worldwide shortage of oncology nurses, retention is paramount to ensuring that the care patients with cancer receive is not jeopardized. Various strategies were identified to resolve grief and increase nurse retention, including creating supportive work environments, debriefing with colleagues, providing EOL and grief education, and altering patient care assignments. Future research on emerging technologies and their effects on oncology nurse coping and retention strategies also was suggested.

Understanding Grief within a Cultural Context

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... the loved ones who are preparing for their loss. Culture and the meaning of death Every culture has ... and mourning practices of a person from another culture. Related Resources Coping With Grief Coping With Change After a Loss f t k e P Coping With Cancer ...

Traumatic grief in young people in Sub-Saharan Africa: a scoping review

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Taggart H

2015-07-01

Full Text Available Holly Taggart,1 Sheila Greatrex-White,2 1Mental Health Commission, CentreForum, Westminster, UK; 2School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK Aim: To identify relevant and pertinent themes and interventions within the literature relating to childhood traumatic grief, in order to provide a sound background of evidence for further research and service development. Background: Childhood traumatic grief is caused when a significant person in a child's life dies under circumstances that they perceive to be traumatic. This can leave a child unable to return to the same level of physical and emotional functioning that he or she had prior to the death occurring. In Sub-Saharan Africa, there is an increased risk for childhood traumatic grief due to a high prevalence of orphanhood, environmental stressors, stigma, and abuse. This can have detrimental effects upon mental health. Methods: The review followed the York methodology: identifying the purpose and agreeing on the strategy beforehand; identifying relevant sources/studies; selecting the studies; charting the data; and collating, summarizing, and reporting results. Results and discussion: Interventions identified to prevent and/or manage traumatic grief included narrative exposure therapy, psychotherapy, mentoring, peer-group support, psychosocial support, a grief and loss therapy session, and memory boxes. Mental health remains neglected within service and policy development as well as in global health spending. The average amount expended on mental health services per person per year in low-income countries is less than $0.25. Only 36% of people in low income countries are covered by a mental health policy, compared with 92% in high income countries. Limitations: The sixth stage of the York methodology was omitted. Only papers written in English were included in the review. Conclusion: Childhood traumatic grief in young people is an important issue

Does knowing that a suicide was "rational" influence grief?

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Brazda, Geoffrey F; Range, Lillian M; Remley, Theodore P; White, Carolyn C

2018-03-15

Counseling professionals and graduate students (N = 117) recruited online read a randomly assigned one-paragraph vignette about either a non-rational or rational suicide involving an imaginary loved one. Then, they completed the Grief Experiences Questionnaire (GEQ) about how they would feel. The non-rational suicide group expected significantly more search for explanation than the rational suicide group, but were not significantly different on the other six GEQ subscales. All participants expected few distressing reactions to either vignette, suggesting a one-paragraph vignette may not be sufficient to induce the kind of grief many experience when a loved one dies by suicide.

Prevalence and predictors of parental grief and depression after the death of a child from cancer.

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McCarthy, Maria C; Clarke, Naomi E; Ting, Cheng Lin; Conroy, Rowena; Anderson, Vicki A; Heath, John A

2010-11-01

To investigate patterns of grief and depression in a sample of parents whose child had died of cancer, and to examine factors related to burden of illness and end-of-life care as potential predictors of parental grief and depression outcomes. Fifty-eight parents completed standardized self-report questionnaires measuring prolonged grief disorder (Inventory of Complicated Grief-Revised [ICG-R]) and depression (Beck Depression Inventory-Second Edition [BDI-II]) and participated in structured interviews designed to elicit their perceptions of their child's end-of-life care and burden of illness. The majority of participants were mothers (84%) and the mean length of time since child death was 4.5 (standard deviation [SD] = 2.4) years (range, 1.0-9.8 years). Rates of prolonged grief disorder (PGD) were similar to those reported in other bereaved populations (10.3%); however, 41% of parents met diagnostic criteria for grief-related separation distress. Twenty-two percent of parents reported clinically significant depressive symptoms. Time since death and parental perception of the oncologist's care predicted parental grief symptoms but not depressive symptoms. Perceptions of the child's quality of life during the last month, preparedness for the child's death, and economic hardship also predicted grief and depression outcomes. A minority of parents met criteria for PGD and depression, however, almost half the sample was experiencing significant separation distress associated with persistent longing and yearning for their child. Time since death is a significant predictor of parental psychological distress. This study also highlights the importance of end-of-life factors in parents' long-term adjustment and the need for optimal palliative care to ensure the best possible outcomes for parents.

Grief, Bereavement, and Coping with Loss (PDQ)

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... mental distress than those in the counseling group. Depression related to grief is sometimes treated with drugs. ... Institutes of Health FOLLOW US Facebook Twitter Instagram YouTube Google+ LinkedIn GovDelivery RSS CONTACT INFORMATION Contact Us ...

Grief Experiences and Expectance of Suicide

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Wojtkowiak, Joanna; Wild, Verena; Egger, Jos

2012-01-01

Suicide is generally viewed as an unexpected cause of death. However, some suicides might be expected to a certain extent, which needs to be further studied. The relationships between expecting suicide, feeling understanding for the suicide, and later grief experiences were explored. In total, 142 bereaved participants completed the Grief…

Korean Version of Inventory of Complicated Grief Scale: Psychometric Properties in Korean Adolescents.

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Han, Doug Hyun; Lee, Jung Jae; Moon, Duk-Soo; Cha, Myoung-Jin; Kim, Min A; Min, Seonyeong; Yang, Ji Hoon; Lee, Eun Jeong; Yoo, Seo Koo; Chung, Un-Sun

2016-01-01

We aimed to validate the Inventory of Complicated Grief (ICG)-Korean version among 1,138 Korean adolescents, representing a response rate of 57% of 1,997 students. Participants completed a set of questionnaires including demographic variables (age, sex, years of education, experience of grief), the ICG, the Children's Depression Inventory (CDI) and the Lifetime Incidence of Traumatic Events-Child (LITE-C). Exploratory factor analysis was performed to determine whether the ICG items indicated complicated grief in Korean adolescents. The internal consistency of the ICG-Korean version was Cronbach's α=0.87. The test-retest reliability for a randomly selected sample of 314 participants in 2 weeks was r=0.75 (PKaiser-Meyer-Olkin Measure of Sampling Adequacy=0.911; Bartlett's Test of Sphericity, χ(2)=13,144.7, P<0.001). After omission of 3 items, the value of Cronbach's α increased from 0.87 for the 19-item ICG-Korean version to 0.93 for the 16-item ICG-Korean version. These results suggest that the ICG is a useful tool in assessing for complicated grief in Korean adolescents. However, the 16-item version of the ICG appeared to be more valid compared to the 19-item version of the ICG. We suggest that the 16-item version of the ICG be used to screen for complicated grief in Korean adolescents.

Prolonged grief: where to after Diagnostic and Statistical Manual of Mental Disorders, 5th Edition?

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Bryant, Richard A

2014-01-01

Although there is much evidence for the construct of prolonged grief, there was much controversy over the proposal to introduce a prolonged grief diagnosis into Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), and it was finally rejected as a diagnosis in DSM-5. This review outlines the evidence for and against the diagnosis, and highlights the implications of the DSM-5 decision. Convergent evidence indicates that prolonged grief characterized by persistently severe yearning for the deceased is a distinct construct from bereavement-related depression and anxiety, is associated with marked functional impairment, is responsive to targeted treatments for prolonged grief, and has been validated across different cultures, age groups, and types of bereavement. Although DSM-5 has rejected the construct as a formal diagnosis, evidence continues to emerge on related mechanisms, including maladaptive appraisals, memory and attentional processes, immunological and arousal responses, and neural circuitry. It is most likely that the International Classification of Diseases (ICD-11) will introduce a diagnosis to recognize prolonged grief, even though DSM-5 has decided against this option. It is probable that the DSM-5 decision may result in more prolonged grief patients being incorrectly diagnosed with depression after bereavement and possibly incorrectly treated. The DSM-5 decision is unlikely to impact on future research agendas.

Attachment styles, grief responses, and the moderating role of coping strategies in parents bereaved by the Sewol ferry accident

OpenAIRE

Huh, Hyu Jung; Kim, Kyung Hee; Lee, Hee-Kyung; Chae, Jeong-Ho

2018-01-01

ABSTRACT Background: Previous studies on the influence of different types of attachment on grief responses have yielded contradictory outcomes. Little research has been conducted to identify the psychological processes that moderate the relationship between attachment representations and patterns of grief in disaster-related grief. Objective: The present study examines the effects of different attachment types on the grief responses of parents bereaved by loss of a child in a ferry accident, ...

Distinguishing Symptoms of Grief and Depression in a Cohort of Advanced Cancer Patients

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Jacobsen, Juliet C.; Zhang, Baohui; Block, Susan D.; Maciejewski, Paul K.; Prigerson, Holly G.

2010-01-01

Several studies have shown that the symptoms of grief are different from symptoms of depression among bereaved family members. This study is an attempt to replicate this finding among advanced cancer patients and examine clinical correlates of patient grief and depression. Analyses were conducted on data from interviews with 123 advanced cancer…

Effects of Mental Health Support on the Grief of Bereaved People Caused by Sewol Ferry Accident

OpenAIRE

Han, Hyesung; Noh, Jin-Won; Huh, Hyu jung; Huh, Seung; Joo, Ji-Young; Hong, Jin Hyuk; Chae, Jeong-Ho

2017-01-01

Few studies have assessed the overall effects of multi-centered, complicated mental health support on the grief process. This study investigated the broader influence of mental health support provided practically to the bereaved family on the severity of complicated grief. Ninety-three bereaved family members of the Sewol ferry accident were recruited. Severity of complicated grief, post-traumatic stress disorder (PTSD) and depressive disorder was assessed through self-reporting questionnaire...

From grief, guilt pain and stigma to hope and pride - a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth.

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Burden, Christy; Bradley, Stephanie; Storey, Claire; Ellis, Alison; Heazell, Alexander E P; Downe, Soo; Cacciatore, Joanne; Siassakos, Dimitrios

2016-01-19

Despite improvements in maternity healthcare services over the last few decades, more than 2.7 million babies worldwide are stillborn each year. The global health agenda is silent about stillbirth, perhaps, in part, because its wider impact has not been systematically analysed or understood before now across the world. Our study aimed to systematically review, evaluate and summarise the current evidence regarding the psychosocial impact of stillbirth to parents and their families, with the aim of improving guidance in bereavement care worldwide. Systematic review and meta-summary (quantitative aggregation of qualitative findings) of quantitative, qualitative, and mixed-methods studies. All languages and countries were included. Two thousand, six hundred and nineteen abstracts were identified; 144 studies were included. Frequency effect sizes (FES %) were calculated for each theme, as a measure of their prevalence in the literature. Themes ranged from negative psychological symptoms post bereavement (77 · 1) and in subsequent pregnancies (27 · 1), to disenfranchised grief (31 · 2), and incongruent grief (28 · 5), There was also impact on siblings (23 · 6) and on the wider family (2 · 8). They included mixed-feelings about decisions made when the baby died (12 · 5), avoidance of memories (13 · 2), anxiety over other children (7 · 6), chronic pain and fatigue (6 · 9), and a different approach to the use of healthcare services (6 · 9). Some themes were particularly prominent in studies of fathers; grief suppression (avoidance)(18 · 1), employment difficulties, financial debt (5 · 6), and increased substance use (4 · 2). Others found in studies specific to mothers included altered body image (3 · 5) and impact on quality of life (2 · 1). Counter-intuitively, Some themes had mixed connotations. These included parental pride in the baby (5 · 6), motivation for engagement in healthcare

Understanding bereavement, grief, and mourning: implications for donation and transplant professionals.

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Corr, Charles A; Coolican, Margaret B

2010-06-01

This article surveys recent literature on bereavement, grief, and mourning. It offers a review of the state of the art of current understandings of those topics to assist professionals who work in the field of organ and tissue donation and transplantation. The article's goal is to provide well-developed and up-to-date education and knowledge about bereavement, grief, and mourning to supplement the natural skills and experience of donation and transplant professionals in their work with bereaved persons.

Medical comorbidity in complicated grief: Results from the HEAL collaborative trial.

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Robbins-Welty, Gregg; Stahl, Sarah; Zhang, Jun; Anderson, Stewart; Schenker, Yael; Shear, M Katherine; Simon, Naomi M; Zisook, Sidney; Skritskaya, Natalia; Mauro, Christina; Lebowitz, Barry D; Reynolds, Charles F

2018-01-01

To describe medical comorbidity in persons with Complicated Grief (CG) and to test whether medical comorbidity in individuals with CG is associated with the severity and duration of CG, after adjusting for age, sex, race, and current depressive symptoms. In exploratory analyses, we compared data from participants in an NIMH-sponsored multisite clinical trial of CG ("HEAL": "Healing Emotions After Loss") to archival data from participants matched on age, gender, and race/ethnicity, stratified by the presence or absence of current major depression. We used the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) as a measure of medical polymorbidity. We investigated the association between CG and medical comorbidity via multiple linear regression, adjusting for sociodemographic and clinical variables, including severity of depressive symptoms. Chronological age and severity of co-occurring symptoms of major depression correlated with cumulative medical polymorbidity in persons with Complicated Grief. The severity of CG and the time since loss did not correlate with global medical polymorbidity (CIRS-G score). Nor was there an interaction between severity of depressive symptoms and severity of CG symptoms in predicting global CIRS-G score. Cumulative medical comorbidity, as measured by CIRS-G scores, was greater in subjects with current major depression ("DEPRESSED") than in CG subjects, and both DEPRESSED and CG subjects had greater medical morbidity than CONTROLS. Medical comorbidity is prevalent in Complicated Grief, associated with increasing age and co-occurring depressive symptoms but apparently not with chronicity and severity of Complicated Grief per se. This observation suggests that treating depression in the context of CG may be important to managing medical conditions in individuals with Complicated Grief to attenuate or prevent the long-term medical sequelae of CG. Copyright © 2017 Elsevier Ltd. All rights reserved.

Opportunities for mourning when grief is disenfranchised: descendants of Nazi perpetrators in dialogue with Holocaust survivors.

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Livingston, Kathy

2010-01-01

This article explores the concepts of unmourned and disenfranchised grief as a way to understand the experiences of adult children of Nazi perpetrators, who grew up with cultural norms of grieving alone or in silence. The scholarly literature on descendants of Nazis reflects a group unlikely to warrant empathy or support from others because of the stigma surrounding their family's possible involvement in the Holocaust atrocities. This article uses, as a case study approach, the testimony given by Monika Hertwig, the adult daughter of a high ranking Nazi, who appears in the documentary film, Inheritance. From the perspective of disenfranchised grief, defined as grief that is not socially recognized or supported, the article links Monika's testimony with existing research from in-depth interviews with other descendants of Nazis to suggest that, as a group, they lacked permission to grieve their deceased parents, acknowledgment of their grief, and opportunities to mourn. Based on the theory that the effects of grief can be transgenerational, the disenfranchisement experienced by the "children of the Third Reich" does not have to pass to subsequent generations if opportunities for mourning are made possible and some resolution of grief occurs. Studies have shown that ongoing dialogue groups between Holocaust survivors and descendants of Nazis provide opportunities for mourning to both groups.

Hospice Counsellor Facing the Grief of the Terminally Ill Child and Its Family

Directory of Open Access Journals (Sweden)

Grzegorz Godawa

2012-09-01

Full Text Available The child’s illness, suffering and death provoke many emotions in the family. The ill child and its family both experience grief which is an emotional reaction to the danger of losing health or life. Support offered by home hospices for children aims at overcoming the destructive influence of illness. A hospice counsellor’s task is to improve the ill child and its family’s quality of life. He is helping the family overcome grief and prepare for the child’s death. The hospice team supports the family members who experience anticipatory and later, actual mourning. Preventing pathological effects of grief is a basic challenge for people who offer help.

Conceptualizing suffering and pain.

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Bueno-Gómez, Noelia

2017-09-29

This article aims to contribute to a better conceptualization of pain and suffering by providing non-essential and non-naturalistic definitions of both phenomena. Contributions of classical evidence-based medicine, the humanistic turn in medicine, as well as the phenomenology and narrative theories of suffering and pain, together with certain conceptions of the person beyond them (the mind-body dichotomy, Cassel's idea of persons as "intact beings") are critically discussed with such purpose. A philosophical methodology is used, based on the review of existent literature on the topic and the argumentation in favor of what are found as better definitions of suffering and pain. Pain can be described in neurological terms but cognitive awareness, interpretation, behavioral dispositions, as well as cultural and educational factors have a decisive influence on pain perception. Suffering is proposed to be defined as an unpleasant or even anguishing experience, severely affecting a person at a psychophysical and existential level. Pain and suffering are considered unpleasant. However, the provided definitions neither include the idea that pain and suffering can attack and even destroy the self nor the idea that they can constructively expand the self; both perspectives can b e equally useful for managing pain and suffering, but they are not defining features of the same. Including the existential dimension in the definition of suffering highlights the relevance of suffering in life and its effect on one's own attachment to the world (including personal management, or the cultural and social influences which shape it). An understanding of pain and suffering life experiences is proposed, meaning that they are considered aspects of a person's life, and the self is the ever-changing sum of these (and other) experiences. The provided definitions will be useful to the identification of pain and suffering, to the discussion of how to relieve them, and to a better understanding

Cultural processes in psychotherapy for perinatal loss: Breaking the cultural taboo against perinatal grief.

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Markin, Rayna D; Zilcha-Mano, Sigal

2018-03-01

This paper argues that there is a cultural taboo against the public recognition and expression of perinatal grief that hinders parents' ability to mourn and their psychological adjustment following a loss. It is proposed that this cultural taboo is recreated within the therapy relationship, as feelings of grief over a perinatal loss are minimized or avoided by the therapist and parent or patient. Importantly, it is suggested that if these cultural dynamics are recognized within the therapy relationship, then psychotherapy has the immense opportunity to break the taboo by validating the parent's loss as real and helping the parent to mourn within an empathic and affect-regulating relationship. Specifically, it is suggested that therapists break the cultural taboo against perinatal grief and help parents to mourn through: acknowledging and not pathologizing perinatal grief reactions, considering intrapsychic and cultural factors that impact a parent's response to loss, exploring cultural reenactments within the therapy relationship, empathizing with the parent's experience of loss and of having to grieve within a society that does not recognize perinatal loss, coregulating the parent's feelings of grief and loss, and helping patients to create personally meaningful mourning rituals. Lastly, the impact of within and between cultural differences and therapist attitudes on the therapy process is discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Of Pain and Childbirth.

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Lyerly, Anne Drapkin

2017-01-01

Childbirth is often understood as a paradigmatically "happy" event where good outcomes are expected and the process anticipated as a reason for celebration. Yet the narratives in this volume reflect sadness and grief, even when a healthy child is born. In this essay, I interrogate the genesis of and our relationship to grief in birth. To the extent such grief is a product of the chasm between the imagined ideal and what women experience, we may redress such grief by orienting around a more robust and woman-centered notion of the "good birth". Yet there is a way in which grief is also intrinsic to birth, and turning away from the loss that birth by its nature entails may compound the suffering of childbearing women. Beginning with the observation that the one narrative in which grief is accepted and attended to-a full term stillbirth-also stands out for the exemplary care provided, I consider the possibility that making space for grief in births, including those with good outcomes, will lead us to better ways of thinking about birth and providing care for childbearing women.

Grief and Horses: Putting the Pieces Together

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Symington, Ashley

2012-01-01

The effectiveness of grief counseling may be enhanced through the utilization of equine-assisted psychotherapy (EAP). An experiential, solution-focused, and natural approach, EAP provides clients with the opportunity to discover solutions to challenges that exist within themselves. Counselors and equine specialists team with horses to provide a…

Before Kubler-Ross: lessons about grief from the book of Job.

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Lyon, D S

2000-07-01

Medicine is as old as the human species, and medical literature is among the earliest writing. Current research is of great help in identifying new interventions, but a great deal of the art of medicine is showcased in ancient works. The 20th century saw a plethora of books, articles, and monographs on the subjects of grief, death and dying, and suffering, but none of these has provided greater insight than the biblical book of Job. Excerpts from Job illustrate both the nature of grief and appropriate intervention when it is confronted.

Grief as a Social Emotion: Theoretical Perspectives

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Jakoby, Nina R.

2012-01-01

The article explores a sociological perspective on grief as a social emotion. Focusing on the social bond with the deceased, the self-concept of the survivor or the power of feeling rules, general sociological theories of emotions (symbolic interactionism, structural theory, behavioral theory) have the potential to deepen the understanding of…

Grief and culture: a checklist

OpenAIRE

Walter, Tony

2010-01-01

All groups have a culture. This article is intended to help the bereavement practitioner better understand the support needs of clients from other cultures. It sets out and explains a simple checklist of questions designed to explore cultural practices and attitudes to grief and bereavement. The questions cover the obligations mourners feel towards the dead and towards society; who should be mourned; what should be done with the dead; what should be done with emotions; the inclusion or exclus...

Persistent Complex Bereavement Disorder and Culture: Early and Prolonged Grief in Nepali Widows.

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Kim, Jane; Tol, Wietse A; Shrestha, Abina; Kafle, Hari Maya; Rayamajhi, Rajin; Luitel, Nagendra P; Thapa, Lily; Surkan, Pamela J

2017-01-01

Persistent complex bereavement disorder (PCBD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has not been well studied in socioculturally diverse populations. Thus, this qualitative study examined (a) how widows in Nepal understand grief, (b) whether a local construct of PCBD exists, and (c) its comparability with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), terminology. Using an adapted Explanatory Model Interview Catalogue (EMIC) framework, semistructured interviews with 25 widows and 12 key informants, as well as three focus-group discussions (n = 20), were conducted between October 2014 and April 2015. Through an inductive grounded theory-based approach, we used the constant comparative method, iteratively coding transcripts to identify themes and patterns in the data. Also, we created two lists of grief responses, one of early reactions and another all reactions to grief, based on the frequency of mention. No single term for grief was reported. Widows reported a local construct of PCBD, which was broadly compatible with DSM-5 terminology but with important variation reflecting societal influence. Surviving torture during conflict, economic and family stressors, and discrimination were mentioned as important determinants that prolong and complicate grief. Suicidal ideation was common, with about 31% and 62% of widows reporting past-year and lifetime suicidality, respectively. Findings may not be generalizable to all Nepali widows; participants were recruited from a non-governmental organization, from Kathmandu and its neighboring districts, and were primarily of reproductive age. While PCBD symptoms proposed in DSM-5 were mentioned as relevant by study participants, some components may need adaptation for use in non-Western settings, such as Nepal.

Effects of Mental Health Support on the Grief of Bereaved People Caused by Sewol Ferry Accident

NARCIS (Netherlands)

Han, Hyesung; Noh, Jin-Won; Huh, Hyu Jung; Huh, Seung; Joo, Ji-Young; Hong, Jin Hyuk; Chae, Jeong-Ho

Few studies have assessed the overall effects of multi-centered, complicated mental health support on the grief process. This study investigated the broader influence of mental health support provided practically to the bereaved family on the severity of complicated grief. Ninety-three bereaved

Death by request in Switzerland: posttraumatic stress disorder and complicated grief after witnessing assisted suicide.

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Wagner, B; Müller, J; Maercker, A

2012-10-01

Despite continuing political, legal and moral debate on the subject, assisted suicide is permitted in only a few countries worldwide. However, few studies have examined the impact that witnessing assisted suicide has on the mental health of family members or close friends. A cross-sectional survey of 85 family members or close friends who were present at an assisted suicide was conducted in December 2007. Full or partial Post-Traumatic Distress Disorder (PTSD; Impact of Event Scale-Revised), depression and anxiety symptoms (Brief Symptom Inventory) and complicated grief (Inventory of Complicated Grief) were assessed at 14 to 24 months post-loss. Of the 85 participants, 13% met the criteria for full PTSD (cut-off≥35), 6.5% met the criteria for subthreshold PTSD (cut-off≥25), and 4.9% met the criteria for complicated grief. The prevalence of depression was 16%; the prevalence of anxiety was 6%. A higher prevalence of PTSD and depression was found in the present sample than has been reported for the Swiss population in general. However, the prevalence of complicated grief in the sample was comparable to that reported for the general Swiss population. Therefore, although there seemed to be no complications in the grief process, about 20% of respondents experienced full or subthreshold PTSD related to the loss of a close person through assisted suicide. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Attachment styles, grief responses, and the moderating role of coping strategies in parents bereaved by the Sewol ferry accident.

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Huh, Hyu Jung; Kim, Kyung Hee; Lee, Hee-Kyung; Chae, Jeong-Ho

2017-01-01

Background : Previous studies on the influence of different types of attachment on grief responses have yielded contradictory outcomes. Little research has been conducted to identify the psychological processes that moderate the relationship between attachment representations and patterns of grief in disaster-related grief. Objective : The present study examines the effects of different attachment types on the grief responses of parents bereaved by loss of a child in a ferry accident, along with the moderating role of coping strategies. Methods : Bereaved parents ( n  = 81) completed self-report questionnaires evaluating attachment, coping strategies, complicated grief, and shame/guilt. We performed correlational analyses to examine the associations among variables. We also conducted hierarchical regression analyses and simple slope analyses to examine the moderation effects of coping strategies. Results : Anxious attachment was associated with severe shame/guilt, and avoidant attachment correlated with complicated grief. Anxious attachment was positively associated with all types of coping strategies, and avoidant attachment was negatively related to problem- and emotion-focused coping. The use of problem-focused coping strategies was a significant moderator of the relationship between the avoidant attachment dimension and shame/guilt. Avoidant attachment had a significant effect on shame/guilt in groups with a high level of problem-focused coping. In contrast, none of the coping strategies significantly moderated the relationship between anxious attachment and grief response. Conclusions : The results suggest that people with highly avoidant attachment might be overwhelmed by shame and guilt when they try to use problem-focused coping strategies. This finding suggests that grief interventions should be organized with consideration of individual differences in attachment representations.

Grief Interrupted: The Experience of Loss Among Incarcerated Women

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Harner, Holly M.; Hentz, Patricia M.; Evangelista, Maria Carmela

2011-01-01

Incarcerated women face a number of stressors apart from the actual incarceration. Nearly half of all women in prison experience the death of a loved one during their incarceration. Our purpose for this study was to explore the experience of grief and loss among incarcerated women using a phenomenological method. Our study approach followed van Manen's method of phenomenology and Munhall's description of existential lifeworlds. Our analysis revealed four existential lifeworlds: temporality: frozen in time; spatiality: no place, no space to grieve; corporeality: buried emotions; and relationality: never alone, yet feeling so lonely. The findings generated from this study can help mental health providers as well as correctional professionals develop policies and programs that facilitate the grief process of incarcerated women within the confines of imprisonment. PMID:20581074

Supporting in grief and burnout of the nursing team from pediatric units in Chilean hospitals.

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Vega, Paula Vega; Rodriguez, Rina González; Galdamez, Natalie Santibáñez; Molina, Camila Ferrada; Orellana, Javiera Spicto; Villanueva, Antonia Sateler; Melo, Jose Bustos

2017-01-01

Objective To know the levels of Burnout Syndrome and perception of grief support in nursing teams of oncology and pediatric intensive care in public hospitals in Chile. Method A study of descriptive cross-sectional design. The Maslach Burnout Inventory and the Grief Support Health Care Scale were applied to university-level and technical nursing professionals between March and November 2015. An analysis to compare the means was performed with use of the Student's t-test, and the level of significance was set at 5%. Results The study included 153 professionals. Results show 4% of professionals have Burnout Syndrome (BS) and 89% are at risk of having it. Oncology professionals are at higher risk as they present higher levels of emotional exhaustion and lower levels of personal fulfillment. Half of professionals have a high level of perception of grief support, which is greater in the oncology team. Conclusion Professionals working in pediatric oncology units are at increased risk of Burnout Syndrome and grief support may be a mediating factor in this process.

Rates and risks for prolonged grief disorder in a sample of orphaned and widowed genocide survivors.

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Schaal, Susanne; Jacob, Nadja; Dusingizemungu, Jean-Pierre; Elbert, Thomas

2010-07-06

The concept of Prolonged Grief Disorder (PGD) has been defined in recent years by Prigerson and co-workers, who have developed and empirically tested consensus and diagnostic criteria for PGD. Using these most recent criteria defining PGD, the aim of this study was to determine rates of and risks for PGD in survivors of the 1994 Rwandan genocide who had lost a parent and/or the husband before, during or after the 1994 events. The PG-13 was administered to 206 orphans or half orphans and to 194 widows. A regression analysis was carried out to examine risk factors of PGD. 8.0% (n = 32) of the sample met criteria for PGD with an average of 12 years post-loss. All but one person had faced multiple losses and the majority indicated that their grief-related loss was due to violent death (70%). Grief was predicted mainly by time since the loss, by the violent nature of the loss, the severity of symptoms of posttraumatic stress disorder (PTSD) and the importance given to religious/spiritual beliefs. By contrast, gender, age at the time of bereavement, bereavement status (widow versus orphan), the number of different types of losses reported and participation in the funeral ceremony did not impact the severity of prolonged grief reactions. A significant portion of the interviewed sample continues to experience grief over interpersonal losses and unresolved grief may endure over time if not addressed by clinical intervention. Severity of grief reactions may be associated with a set of distinct risk factors. Subjects who lose someone through violent death seem to be at special risk as they have to deal with the loss experience as such and the traumatic aspects of the loss. Symptoms of PTSD may hinder the completion of the mourning process. Religious beliefs may facilitate the mourning process and help to find meaning in the loss. These aspects need to be considered in the treatment of PGD.

Representations of African Americans in the Grief and Mourning Literature from 1998 to 2014: A Systematic Review.

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Granek, Leeat; Peleg-Sagy, Tal

2015-01-01

The authors examined representations of African Americans in the grief literature to assess (a) frequencies; (b) content; and (c) use of universalist or a contextualized framework. They conducted searches in 3 databases that target the grief literature published in the last 15 years. Fifty-nine articles met the criteria. There are a small number of studies published on African Americans and these tend to focus on homicide. Many studies had incomplete methods. Comparison studies were common and pathological grief outcomes that were validated on White populations were used as outcome variables with African American participants.

Parental Grief Following the Brain Death of a Child: Does Consent or Refusal to Organ Donation Affect Their Grief?

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Bellali, Thalia; Papadatou, Danai

2006-01-01

The purpose of this study was to investigate the grieving process of parents who were faced with the dilemma of donating organs and tissues of their underage brain dead child, and to explore the impact of their decision on their grief process. A grounded theory methodology was adopted and a semi-structured interview was conducted with 11 bereaved…

Using Narrative Approach for Anticipatory Grief Among Family Caregivers at Home

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Toyama, Hiroko; Honda, Akiko

2016-01-01

Family caregivers of patients with terminal-stage cancer have numerous roles as caregivers, which can influence their anticipatory grief. The purpose of this study was to clarify how talking to family caregivers of patients with terminal illness using the narrative approach can influence such caregivers’ process of anticipatory grief. We conducted the narrative approach as an intervention with two family caregivers several times and qualitatively analyzed their narratives. The results indicated that these family caregivers had two primary roles—family member and caregiver—and that family caregivers felt trapped in their caregiver role. The narrative approach helped them transition into the role needed for coping with the loss. PMID:28462354

The American Indian Holocaust: Healing Historical Unresolved Grief.

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Brave Heart, Maria Yellow Horse; DeBruyn, Lemyra M.

1998-01-01

Argues for the existence of historical unresolved grief among American Indians. Outlines the historical legacy of war, genocide, and boarding schools resulting in intergenerational trauma and a host of associated social problems. Suggests healing strategies that integrate modern and traditional approaches to healing at the individual, family, and…

Using Multidimensional Grief Theory to Explore Effects of Deployment, Reintegration, and Death on Military Youth and Families

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Kaplow, Julie B.; Layne, Christopher M.; Saltzman, William R.; Cozza, Stephen J.; Pynoos, Robert S.

2015-01-01

To date, the U.S. military has made major strides in acknowledging and therapeutically addressing trauma and Posttraumatic Stress Disorder (PTSD) in service members and their families. However, given the nature of warfare and high rates of losses sustained by both military members (e.g., deaths of fellow unit members) and military families (e.g., loss of a young parent who served in the military), as well as the ongoing threat of loss that military families face during deployment, we propose that a similar focus on grief is also needed to properly understand and address many of the challenges encountered by bereaved service members, spouses, and children. In this article, we describe a newly developed theory of grief (Multidimensional Grief Theory) and apply it to the task of exploring major features of military-related experiences during the phases of deployment, reintegration, and the aftermath of combat death—especially as they impact children. We also describe implications for designing preventive interventions during each phase and conclude with recommended avenues for future research. Primary aims are to illustrate: (1) the indispensable role of theory in guiding efforts to describe, explain, predict, prevent, and treat maladaptive grief in military service members, children, and families; (2) the relevance of multidimensional grief theory for addressing both losses due to physical death as well as losses brought about by extended physical separations to which military children and families are exposed during and after deployment; and (3) a focus on military-related grief as a much-needed complement to an already-established focus on military-related PTSD. PMID:23760905

Excluding parental grief: A critical discourse analysis of bereavement accommodation in Canadian labour standards.

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Macdonald, Mary Ellen; Kennedy, Kimberly; Moll, Sandra; Pineda, Carolina; Mitchell, Lisa M; Stephenson, Peter H; Cadell, Susan

2015-01-01

Grief following child loss is profoundly destabilizing with serious long-term repercussions for bereaved parents. Employed parents may need time away from work to deal with this loss. The purpose of this study was to reflect upon the ways labour policies and practices respond to parental bereavement. Critical discourse analysis was used to examine labour policies and practices related to employment leave for bereaved parents in Canada. Results were compared to international labour standards. Universally, employment policies provide only for the practical issues of bereavement. Commonly, leave is three days, unpaid, and meant to enable ceremonial obligations. Policies do not acknowledge the long-term suffering caused by grief or the variable intensity of different kinds of loss. Managerial, moral, normative and neoliberal values embedded in these policies efface the intensely personal experience of grief, thereby leaving employees at risk for serious health and workplace safety issues. Bereavement leave currently understands grief as a generic, time-limited state with instrumental tasks and ceremonial obligations. In contrast, research characterizes responses to child loss as intense, highly personal experiences for which healing and recovery can take years. This disconnect is especially problematic when viewed through the lens of employee wellbeing, reintegration and workplace productivity.

Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG): toward integrated treatment of symptoms related to traumatic loss

NARCIS (Netherlands)

Smid, Geert E.; Kleber, Rolf J.; de la Rie, Simone M.; Bos, Jannetta B. A.; Gersons, Berthold P. R.; Boelen, Paul A.

2015-01-01

Background: Traumatic events such as disasters, accidents, war, or criminal violence are often accompanied by the loss of loved ones, and may then give rise to traumatic grief. Traumatic grief refers to a clinical diagnosis of persistent complex bereavement disorder (PCBD) with comorbid (symptoms

Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG) : toward integrated treatment of symptoms related to traumatic loss

NARCIS (Netherlands)

Smid, Geert E; Kleber, Rolf J; de la Rie, Simone M; Bos, Jannetta B A; Gersons, Berthold P R; Boelen, Paul A

2015-01-01

BACKGROUND: Traumatic events such as disasters, accidents, war, or criminal violence are often accompanied by the loss of loved ones, and may then give rise to traumatic grief. Traumatic grief refers to a clinical diagnosis of persistent complex bereavement disorder (PCBD) with comorbid (symptoms

The Role of Defense Mechanisms, Personality and Demographical Factors on Complicated Grief following Death of a loved one by Cancer

Directory of Open Access Journals (Sweden)

Isaac Rahimian-Boogar

2015-10-01

Full Text Available Objective: Identification of the risk factors and psychological correlates of prolonged grief disorder is vital for health promotions in relatives of persons who died of cancer. The aim of this research was to investigate the role of defense mechanisms, character dimension of personality and demographic factors on complicated grief following a loss of a family member to cancer .Method: A number of 226 persons who had lost a family member to cancer in a cancer institute at Tehran University of Medical Science were selected through compliance sampling and completed the Inventory of complicated Grief-Revised (ICG-R, the Defense Styles Questionnaire (DSQ, the Character dimension of Temperament and Character Inventory (TCI, and the Demographical questionnaire. Data were analyzed by stepwise multiple regression analysis, using the PASW version 18 .Results: Findings revealed that neurotic defense style had a significant positive predictive role in the complicated grief; and cooperativeness, age of the deceased person, self-transcendence and mature defense style had a significant negative predictive role in complicated grief (p<0.001. R2 was 0.73 for the final model (p<.001.Conclusion: The results revealed that two character dimensions (low cooperativeness and self-transcendence, high neurotic defense style and young age of the deceased person were involved in the psychopathological course of the complicated and prolonged grief. It was concluded that personality characteristics of the grieving persons and demographics of the deceased person should be addressed in designing tailored interventions for complicated grief.

Attachment style dimensions can affect prolonged grief risk in caregivers of terminally ill patients with cancer.

Science.gov (United States)

Lai, Carlo; Luciani, Massimiliano; Galli, Federico; Morelli, Emanuela; Cappelluti, Roberta; Penco, Italo; Aceto, Paola; Lombardo, Luigi

2015-12-01

The aim of the present study was to evaluate the predictive role of attachment dimensions on the risk of prolonged grief. Sixty caregivers of 51 terminally ill patients with cancer who had been admitted in a hospice were selected. Caregivers were interviewed using Attachment Scale Questionnaire, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Prolonged Grief Disorder 12 (PG-12). The consort caregivers showed higher PG-12 level compared to the sibling caregivers. Anxiety, depression, need for approval, and preoccupation with relationships levels were significantly correlated with PG-12 scores. Female gender, high levels of depression, and preoccupation with relationships significantly predicted higher levels of prolonged grief risk. © The Author(s) 2014.

Parental Reactions to the Special Education Individual Education Program Process: Looking through the Lens of Grief

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Haley, Melinda; Hammond, Helen; Ingalls, Lawrence; Marín, Merranda Romaro

2013-01-01

Parental grief reactions have typically been examined in situations where parents have a child diagnosed with a major medical or mental health condition. This study used the grief and loss model as conceptualized by Kubler-Ross (1969), Lamb (1988), and Kubler-Ross and Kessler (2005) as a foundation in examining parental reactions when a child has…

"Every time that month comes, I remember": using cognitive interviews to adapt grief measures for use with bereaved adolescents in South Africa.

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Taylor, Tory M; Thurman, Tonya R; Nogela, Lineo

2016-07-01

To assess standard grief measures through cognitive interviews with bereaved adolescents in Free State, South Africa, and make recommendations designed to improve the measurement of grief in this and similar populations. Twenty-one parentally bereaved adolescents participated in semi-structured cognitive interviews about the Core Bereavement Items (CBI) questionnaire, Grief Cognitions Questionnaire for Children (GCQ-C), or Intrusive Griefs Thoughts Scale (IGTS). Interviewees offered valuable insights for improving grief measurement with this population (e.g., consensus that not thinking frequently about a deceased loved one was shameful, aversion to terms including "died"). Participants were better able to apply response options denoting specific frequencies (e.g., "once or twice a week") versus general ones (e.g., "a little bit of the time"). Questions intended to gauge grief commonly elicited responses reflecting the impact of loss on adolescents' basic survival instead of psychological wellbeing. The need for psychological support is high among orphans and vulnerable children. Tools for measuring psychological outcomes can provide evidence of programme effects and guide decision making about investment. Grief measures used with adolescents in South Africa should account for the issues raised by cognitive interviewees in the study, including question and response option complexity, linguistic preferences, and cultural norms.

Do anticipatory grief and preparedness affect distress in bereaved caregivers?

DEFF Research Database (Denmark)

Nielsen, Mette Kjærgaard

Objective Family caregivers of terminally ill patients are in a vulnerable position, and previous studies show that bereaved caregivers are at risk of psychological distress. Pre-loss grief symptoms seem to predict post-loss psychological distress, while preparedness for a looming loss tends...... to decrease distress. The aim of this nation-wide study was to investigate the association of both anticipatory grief symptoms and preparedness with psychological distress in bereaved family caregivers. Methods A list of all adult patients in Denmark receiving drug reimbursement for terminal illness...... was retrieved from the Danish Health and Medicines Authority on a weekly basis during 2012. All newly registered patients were requested by letter to pass on an enclosed baseline questionnaire to their closest relative. Responding caregivers bereaved within six months received a follow-up questionnaire six...

How do adults with mild learning disabilities experience bereavement and grief? A qualitative exploration.

OpenAIRE

McRitchie, Robyn

2012-01-01

Background: The vast majority of research into the experiences of people with learning disabilities (LD) in regard to bereavement and grief involves the collection of data from second-hand sources, or via quantitative measures. This qualitative study aimed to explore the lived experiences of bereavement and grief in a group of adults with mild LD. Methods: Semi-structured interviews were carried out with 13 adults (aged 20-72 years) with mild LD who had experienced bereaveme...

Using multidimensional grief theory to explore the effects of deployment, reintegration, and death on military youth and families.

Science.gov (United States)

Kaplow, Julie B; Layne, Christopher M; Saltzman, William R; Cozza, Stephen J; Pynoos, Robert S

2013-09-01

To date, the US military has made major strides in acknowledging and therapeutically addressing trauma and post-traumatic stress disorder (PTSD) in service members and their families. However, given the nature of warfare and high rates of losses sustained by both military members (e.g., deaths of fellow unit members) and military families (e.g., loss of a young parent who served in the military), as well as the ongoing threat of loss that military families face during deployment, we propose that a similar focus on grief is also needed to properly understand and address many of the challenges encountered by bereaved service members, spouses, and children. In this article, we describe a newly developed theory of grief (multidimensional grief theory) and apply it to the task of exploring major features of military-related experiences during the phases of deployment, reintegration, and the aftermath of combat death--especially as they impact children. We also describe implications for designing preventive interventions during each phase and conclude with recommended avenues for future research. Primary aims are to illustrate: (1) the indispensable role of theory in guiding efforts to describe, explain, predict, prevent, and treat maladaptive grief in military service members, children, and families; (2) the relevance of multidimensional grief theory for addressing both losses due to physical death as well as losses brought about by extended physical separations to which military children and families are exposed during and after deployment; and (3) a focus on military-related grief as a much-needed complement to an already-established focus on military-related PTSD.

When hope and grief intersect: rates and risks of prolonged grief disorder among bereaved individuals and relatives of disappeared persons in Colombia.

Science.gov (United States)

Heeke, Carina; Stammel, Nadine; Knaevelsrud, Christine

2015-03-01

Forced disappearance is a frequent phenomenon in violent conflicts and regimes, yet little is known about unresolved grief processes as a possible outcome of the disappearance of a loved one. This study investigates prolonged grief disorder (PGD) and its risk factors in a sample of persons who lost a significant other to disappearance as compared with a sample of bereaved individuals, both groups having experienced displacement due to the armed conflict in Colombia. In a cross-sectional study conducted in four Colombian provinces, 73 persons who lost a significant other to disappearance and 222 bereaved individuals completed measures of PGD (PG-13), depression (HSCL-25), and PTSD (PCL-C) via face-to-face interviews. Trauma- and loss-related variables, including the extent to which significant others of disappeared persons hoped that their loved one was still alive, were assessed. Results indicated that 23% of participants who lost a significant other to disappearance met criteria for PGD as compared to 31.5% in bereaved participants. No differences were found between the two groups in terms of symptom severity of PGD, depression, posttraumatic stress disorder, or traumatic exposure. Regression analysis indicated that, among relatives and friends of disappeared persons, the extent of hope predicted PGD above and beyond depression severity whereas among bereaved persons, PGD was predicted by time since the loss, the number of traumatic events and symptom severity of PTSD and depression. The instruments were not validated for use in Colombia; generalizability of findings is limited. Forced disappearance is related to prolonged grief reactions, particularly when those left behind maintain hope that the disappeared person is still alive. Copyright © 2014 Elsevier B.V. All rights reserved.

Grief in Two Guises: "Mourning and Melancholia" Revisited

Science.gov (United States)

Green, Viviane

2013-01-01

This paper is a re-reading of Freud's classic paper. The themes of mourning and melancholia are viewed in relation to children and adolescents with illustrations from case histories. Mourning is interpreted in a broader sense: not only as grief (both expectable and traumatic) but as a response to the developmental process itself as phases of…

Hacia una visión constructivista del Duelo Going to a constructivist model of grief

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Martín Rodríguez Alvaro

2008-09-01

Full Text Available Recientemente NANDA ha revisado su diagnóstico 00136 Duelo (antes Duelo anticipado. La nueva definición de este diagnóstico aprobado en 1980, incluye sutiles cambios que identifican al fenómeno como un proceso normal que incluye respuestas emocionales, físicas, espirituales, intelectuales y sociales. Esto supone un paso hacia la adopción desde la disciplina enfermera de una visión constructivista del duelo, desbancando las corrientes tradicionales que impregnan nuestro trabajo diario. En este artículo, pretendemos acercar al lector a una concepción de la muerte y el duelo desde una postura constructivista, estableciendo comparaciones entre esta tendencia y teorías tradicionales.Recently NANDA has modified his diagnosis 00136 Grief (previously titled "Aticipatory Grieving". The new definition of this diagnosis - dates back of 1980 - includes aspects like emotional, physical, spiritual, intellectual and social answers to the grief; that identifies the grief as a normal response to loss. This supposes that nursing is going to a constructivist model (contemporary theory, not adopting traditional perspectives. In this article, we try to bring the reader over to a conception of the death, the grief and loss from a cognitive-constructivist model, doing a comparisons with traditional theories.

Identifying a combined construct of grief and explosive anger as a response to injustice amongst survivors of mass conflict: A latent class analysis of data from Timor-Leste.

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Susan J Rees

Full Text Available Previous studies have identified high rates of explosive anger amongst post-conflict populations including Timor-Leste. We sought to test whether explosive anger was integrally associated with symptoms of grief amongst the Timorese, a society that has experienced extensive conflict-related losses. In 2010 and 2011 we recruited adults (n = 2964, 18-years and older, living in an urban and a rural village in Timor-Leste. We applied latent class analysis to identify subpopulations based on symptoms of explosive anger and grief. The best fitting model comprised three classes: grief (24%, grief-anger (25%, and a low symptom group (51%. There were more women and urban dwellers in the grief and grief-anger classes compared to the reference class. Persons in the grief and grief-anger classes experienced higher rates of witnessing murder and atrocities and traumatic losses, ongoing poverty, and preoccupations with injustice for the two historical periods of conflict (the Indonesian occupation and the later internal conflict. Compared to the reference class, only the grief-anger class reported greater exposure to extreme deprivations during the conflict, ongoing family conflict, and preoccupations with injustice for contemporary times; and compared to the grief class, greater exposure to traumatic losses, poverty, family conflict and preoccupations with injustice for both the internal conflict and contemporary times. A substantial number of adults in this post-conflict country experienced a combined constellation of grief and explosive anger associated with extensive traumatic losses, deprivations, and preoccupations with injustice. Importantly, grief-anger may be linked to family conflict in this post-conflict environment.

The role of grief symptoms and a sense of injustice in the pathways to post-traumatic stress symptoms in post-conflict Timor-Leste.

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Tay, A K; Rees, S; Steel, Z; Liddell, B; Nickerson, A; Tam, N; Silove, D

2017-08-01

Grief symptoms and a sense of injustice may be interrelated responses amongst persons exposed to mass conflict and both reactions may contribute to post-traumatic stress disorder (PTSD) symptoms. As yet, however, there is a dearth of data examining these relationships. Our study examined the contributions of grief and a sense of injustice to a model of PTSD symptoms that included the established determinants of trauma events, ongoing adversity and severe psychological distress. The study involved a large population sample (n = 2964, response rate: 82.4%) surveyed in post-conflict Timor-Leste. The survey sites included an urban administrative area (suco) in Dili, the capital of Timor-Leste and a rural village located an hour's drive away. Culturally adapted measures were applied to assess conflict related traumatic events (TEs), ongoing adversity, persisting preoccupations with injustice, symptoms of grief, psychological distress (including depressive symptoms) and PTSD symptoms. We tested a series of structural equation models, the final comprehensive model, which included indices of grief symptoms and injustice, producing a good fit. Locating grief symptoms as the endpoint of the model produced a non-converging model. In the final model, strong associations were evident between grief and injustice (β = 0.34, s.e. = 0.02, p < 0.01) and grief and PTSD symptoms (β = 0.14, s.e. = 0.02, p < 0.01). The sense of injustice exerted a considerable effect on PTSD symptoms (β = 0.13, s.e. = 0.03, p < 0.01). In addition, multiple indirect paths were evident, most involving grief and a sense of injustice, attesting to the complex inter-relationship of these factors in contributing to PTSD symptoms. Our findings support an expanded model of PTSD symptoms relevant to post-conflict populations, in which grief symptoms and a sense of injustice play pivotal roles. The model supports the importance of a focus on loss, grief and a sense of injustice in conducting trauma

Optimism in prolonged grief and depression following loss: A three-wave longitudinal study.

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Boelen, Paul A

2015-06-30

There is considerable evidence that optimism, the predisposition to have generalized favorable expectancies for the future, is associated with numerous desirable outcomes. Few studies have examined the association of optimism with emotional distress following the death of a loved one. Doing so is important, because optimism may be an important target for interventions for post-loss psychopathology. In the current study, we examined the degree to which optimism, assessed in the first year post-loss (Time 1, T1), was associated with symptom levels of prolonged grief and depression six months (Time 2, T2) and fifteen months (Time 3, T3) later, controlling for baseline symptoms and also taking into account positive automatic cognitions at T1. Findings showed that higher optimism at T1 was associated with lower concurrent prolonged grief and depression severity. Higher optimism at T1 was also inversely related with depression symptom severity at T2 and T3, but not prolonged grief severity at T2 and T3. Implications of these findings are discussed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Traditional and Contemporary Lakota Death, Dying, Grief, and Bereavement Beliefs and Practices: A Qualitative Study

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Stone, Joseph B.

1998-01-01

Bereavement beliefs and practices in the modern, American culture have been well documented. However, virtually no research has been conducted on traditional and contemporary death, dying, grief, and bereavement beliefs and practices among native tribes, such as the Lakota. The present study was conducted with the Lakota, and fulfilled two goals. iii First, the contemporary and traditional death, dying, grief, and bereavement beliefs and practices of the Lakota were documented and summariz...

The Effectiveness of Family-Based Cognitive-Behavior Grief Therapy to Prevent Complicated Grief in Relatives of Suicide Victims : The Mediating Role of Suicide Ideation

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de Groot, M.; Neeleman, J.; van der Meer, K.; Burger, H.

2010-01-01

Grief interventions are more effective for high risk individuals. The presence of suicide ideation following suicide bereavement was examined to determine whether it indicates a high risk status. Using data from a randomized controlled trial (n =122) on the effectiveness of cognitive-behavior

Family Anticipatory Grief: An Integrative Literature Review.

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Coelho, Alexandra; Barbosa, António

2017-09-01

Despite all the investment in research, uncertainty persists in anticipatory grief (AG) literature, concerning its nuclear characteristics and definition. This review aimed to synthesize recent research in order to develop further knowledge about the family experience of AG during a patient's end of life. An integrative review was performed using standard methods of analysis and synthesis. The electronic databases Medline, Web of Knowledge, and EBSCO and relevant journals were systematically searched since 1990 to October 2015. Twenty-nine articles were selected, the majority with samples composed of caregivers of terminally ill patients with cancer. From systematic comparison of data referring to family end-of-life experience emerged 10 themes, which correspond to AG nuclear characteristics: anticipation of death, emotional distress, intrapsychic and interpersonal protection, exclusive focus on the patient care, hope, ambivalence, personal losses, relational losses, end-of-life relational tasks, and transition. For the majority of family caregivers in occidental society, AG is a highly stressful and ambivalent experience due to anticipation of death and relational losses, while the patient is physically present and needed of care, so family must be functional and inhibit grief expressions. The present study contributes to a deeper conceptualization of this term and to a more sensitive clinical practice.

How adults with an intellectual disability experience bereavement and grief: a qualitative exploration.

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McRitchie, Robyn; McKenzie, Karen; Quayle, Ethel; Harlin, Margaret; Neumann, Katja

2014-01-01

This qualitative study explored the lived experiences of bereavement of 13 adults with an intellectual disability and found that their experiences could be situated within the concept of disenfranchised grief. The latter mediated participants' meaning making of the grieving process illustrated in the themes of intra- and interpersonal bereavement experiences, core beliefs about life and death, level of inclusion, and maintaining a continuing relationship with the deceased. The results suggest that participants experience bereavement and grief in a manner similar to that of the general population and suggest the need for open communication, facilitation of informed choice, and a culture of inclusion.

Factorial structure of complicated grief: associations with loss-related traumatic events and psychosocial impacts of mass conflict amongst West Papuan refugees.

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Tay, Alvin Kuowei; Rees, Susan; Chen, Jack; Kareth, Moses; Silove, Derrick

2016-03-01

Definitions of complicated grief vary across diagnostic systems, being represented as persistent complex bereavement (PCB) in DSM-5 and prolonged grief disorder (PGD) in the proposed revision of the ICD system. A past study in a high-income country has identified a six-factor structure for complicated grief, but there are no data testing this or any other model across cultures. The present study reports findings from a survey amongst West Papuan refugees (n = 230, response rate = 92 %) residing in Port Moresby, Papua New Guinea. We applied culturally adapted measures of conflict-related traumatic event (TEs) (drawing specifically on domains of conflict and loss), symptoms of complicated grief adapted and modified to the culture, and a multidimensional psychosocial index of the broader effects of conflict and displacement. Confirmatory factor analysis yielded a single higher order construct of complicated grief comprising six factors of yearning/preoccupation; shock/disbelief; anger/negative appraisal; behavioural change; estrangement from others/impairment; and a novel dimension of confusion/diminished identity. In contrast, our analysis failed to support DSM or ICD models of PCB or PGD. A Multiple Indicators Multiple Causes (MIMIC) model revealed that traumatic loss and the sense of injustice each were associated with the unitary construct of complicated grief and its subdomains of yearning/preoccupation; shock/disbelief; anger/negative appraisal (exclusive to injustice); and estrangement from others/social impairment (exclusive to TE domain of conflict and loss). Conflict and loss associated with feelings of injustice may be especially pathogenic in generating the anger/negative appraisal component of complicated grief amongst refugees.

Parental grief and relationships after the loss of a stillborn baby.

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Avelin, Pernilla; Rådestad, Ingela; Säflund, Karin; Wredling, Regina; Erlandsson, Kerstin

2013-06-01

to describe the grief of mothers and fathers and its influence on their relationships after the loss of a stillborn baby. a postal questionnaire at three months, one year and two years after stillbirth. a study of mothers and fathers of babies stillborn during a one-year period in the Stockholm region of Sweden. 55 parents, 33 mothers and 22 fathers. mothers and fathers stated that they became closer after the loss, and that the feeling deepened over the course of the following year. The parents said that they began grieving immediately as a gradual process, both as individuals, and together as a couple. During this grieving process their expectations, expressions and personal and joint needs might have threatened their relationship as a couple, in that they individually felt alone at this time of withdrawal. While some mothers and fathers had similar grieving styles, the intensity and expression of grief varied, and the effects were profound and unique for each individual. experiences following a loss are complex, with each partner attempting to come to terms with the loss and the resultant effect on the relationship with their partner. anticipating and being able to acknowledge the different aspects of grief will enable professionals to implement more effective intervention in helping couples grieve both individually and together. Copyright © 2012 Elsevier Ltd. All rights reserved.

Perinatal grief in Latino parents.

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Whitaker, Claudia; Kavanaugh, Karen; Klima, Carrie

2010-01-01

Extensive research exists that describes the meaning of perinatal loss to some parents, but the experience of loss from the perspective of Latino parents is not clearly understood. Additionally, current perinatal bereavement practices used often to facilitate memory making for parents (such as viewing or holding the baby, taking photographs, or collecting mementos) are based on research done primarily with non-Latino families. Are these common practices appropriate for this population? Because there is a paucity of research on this topic, this article describes what has been written over the past 30 years on the topic of grief and perinatal loss in Latino culture.

Men’s Grief, Meaning and Growth

DEFF Research Database (Denmark)

Spaten, Ole Michael; Byrialsen, Mia Nørremark; Langdridge, Darren

2012-01-01

There is a scarcity of research on men's experience of bereavement (Reiniche, 2006), particularly in relation to qualitative research that focuses on the meaning of such an experience. This paper seeks to address this scarcity by presenting the findings from a phenomenological study of the life-w...... phenomenological method of Van Manen (1990) was used to uncover three key themes, labelled grief and self-reflection, meaning of life and loss, and re-figuring the life-world. These themes are discussed in the light of broader existential concerns and the extant literature....

Anguish, Yearning, and Identity: Toward a Better Understanding of the Pregnant Hispanic Woman's Prenatal Care Experience.

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Fitzgerald, Elizabeth Moran; Cronin, Sherill Nones; Boccella, Sarah Hess

2016-09-01

The purpose of this phenomenological study was to seek a better understanding of needs and access issues among pregnant, low-income Hispanic women. Hispanic women who attended a community prenatal education program participated in follow-up focus groups to explore their experiences regarding prenatal education, pregnancy resources, access to, and satisfaction with, the care available to them. Focus groups were facilitated by a leader, bilingual in English and Spanish, with knowledge of the Hispanic culture. Sessions were audiotaped, then translated into English for transcription. Data were analyzed according to guidelines by Colaizzi and three themes emerged: pregnant Hispanic women experienced a sense of anguish (la angustia) from questions and unknowns rampant during pregnancy, leading to a yearning (el anhelo) to learn and understand more, but with a desire to do so without sacrificing native identity (la identidad). Implications of these themes for improving prenatal care for this population are explored. © The Author(s) 2015.

Persistent grief in the aftermath of mass violence: the predictive roles of posttraumatic stress symptoms, self-efficacy, and disrupted worldview.

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Smith, Andrew J; Abeyta, Andrew A; Hughes, Michael; Jones, Russell T

2015-03-01

This study tested a conceptual model merging anxiety buffer disruption and social-cognitive theories to predict persistent grief severity among students who lost a close friend, significant other, and/or professor/teacher in tragic university campus shootings. A regression-based path model tested posttraumatic stress (PTS) symptom severity 3 to 4 months postshooting (Time 1) as a predictor of grief severity 1 year postshootings (Time 2), both directly and indirectly through cognitive processes (self-efficacy and disrupted worldview). Results revealed a model that predicted 61% of the variance in Time 2 grief severity. Hypotheses were supported, demonstrating that Time 1 PTS severity indirectly, positively predicted Time 2 grief severity through undermining self-efficacy and more severely disrupting worldview. Findings and theoretical interpretation yield important insights for future research and clinical application. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Effects of Mental Health Support on the Grief of Bereaved People Caused by Sewol Ferry Accident.

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Han, Hyesung; Noh, Jin Won; Huh, Hyu Jung; Huh, Seung; Joo, Ji Young; Hong, Jin Hyuk; Chae, Jeong Ho

2017-07-01

Few studies have assessed the overall effects of multi-centered, complicated mental health support on the grief process. This study investigated the broader influence of mental health support provided practically to the bereaved family on the severity of complicated grief. Ninety-three bereaved family members of the Sewol ferry accident were recruited. Severity of complicated grief, post-traumatic stress disorder (PTSD) and depressive disorder was assessed through self-reporting questionnaire, inventory of complicated grief (ICG), PTSD Check List-5 (PCL-5) and Patient Health Questionnaire-9 (PHQ-9). We also included demographic, socioeconomic, health-related variables, and Functional Social Support Questionnaire (FSSQ), which affect the ICG score. Participants were divided into 4 groups based on the experience of psychotherapy or psychiatry clinic service before the accident and mental health support after the disaster. In univariate analysis, these 4 groups showed a significant difference in the mean ICG score (P = 0.020). Participants who received mental health support only after the Sewol ferry accident (group 2) showed a lower mean ICG score than those who received neither psychotherapy or psychiatry clinic service before the disaster nor mental health support after the accident (group 4). There was no significant correlation between the ICG score and other variables except for subjective health status measured 1 month after the disaster (P = 0.005). There was no significant difference in PCL-5 (P = 0.140) and PHQ-9 scores (P = 0.603) among groups, respectively. In conclusion, mental health support significantly reduced the severity of grief only in those participants who had not received any psychotherapy or psychiatry clinic service before the accident. © 2017 The Korean Academy of Medical Sciences.

Music Therapy with Bereaved Youth: Expressing Grief and Feeling Better

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McFerran, Katrina

2011-01-01

Music therapy is a promising intervention with bereaved youth. In comparison to other programs, it appears particularly effective for promoting the resolution of grief-related feelings; providing opportunities to express and release feelings through musical participation. Descriptions from music therapy participants are supported by research…

The Emotional Experience of School Change: Resistance, Loss, and Grief.

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Marshak, David

1996-01-01

Ignoring the emotional experience of school change may unintentionally sabotage rational planning. Reinventing schools means attending to educators' emotional experience, particularly their expectations, sense of loss, and resulting grief. School norms must be transformed so that teachers and administrators can have meaningful conversations about…

The Effectiveness of Family-Based Cognitive-Behavior Grief Therapy to Prevent Complicated Grief in Relatives of Suicide Victims: The Mediating Role of Suicide Ideation

Science.gov (United States)

de Groot, Marieke; Neeleman, Jan; van der Meer, Klaas; Burger, Huibert

2010-01-01

Grief interventions are more effective for high risk individuals. The presence of suicide ideation following suicide bereavement was examined to determine whether it indicates a high risk status. Using data from a randomized controlled trial (n = 122) on the effectiveness of cognitive-behavior therapy, the effect of suicide ideation on the…

Bereaved parents' online grief communities: de-tabooing practices or grief-ghettos?

DEFF Research Database (Denmark)

Sandvik, Kjetil; Christensen, Dorthe Refslund; Hård af Segerstad, Ylva

, children are not supposed to die before their parents, old people are supposed to die. Losing a child cuts to the core of human existence. A 100 years ago, the most common death was a child. Today, it is an old person. So the percentage of parents who have suffered the death of a child is comparably small...... compared with people who have lost an old relative. Moreover, the traditional view for socially accepted grief and mourning (at least in protestant Nordic countries) is often that you should not to grieve for too long, not too intensely or not to publicly. A taboo can be said to be a rule against something......-tabooing practices going on. In everyday interaction in the physical world there is a taboo against performing parenthood once your child is dead. It is normal for a parent to talk about their children extensively, as long as it lives. What is to be considered normal, or accepted, is a matter of perspective...

Dyadic coping mediates the relationship between parents’ grief and dyadic adjustment following the loss of a child

OpenAIRE

Albuquerque, Sara; Narciso, Isabel; Pereira, Marco

2018-01-01

Background and Objectives: This study aimed to examine forms of dyadic coping (DC) as mediators of the association between parents’ grief response and dyadic adjustment and to determine whether these indirect effects were moderated by the child’s type of death, timing of death, and age. Design: The study design was cross-sectional. Method: The sample consisted of 197 bereaved parents. Participants completed the Prolonged Grief Disorder Scale, Revised Dyadic Adjustment ...

Inviting Grief into Games

DEFF Research Database (Denmark)

Harrer, Sabine; Schoenau-Fog, Henrik

2015-01-01

facilitation process with Jocoi. It will trace key moments in moving from kick-off workshop to the final game. Finally, the ensuing discussion will highlight learnings for a broader understanding of introducing diversity into games. The question of appropriateness seems to be of particular importance for game......This paper investigates how designers might initiate a dialogue with underrepresented groups, infusing design with individuals’ personal stories and imaginations. It does so alongside the example of Jocoi, a game aiming at mediating the experience of loss and grief over a dead baby. Apart from...... being a taboo subject in general, there is no explanation for the absence of this fairly common experience in games. Drawing on the emotional worlds and tastes of individuals identifying as bereft parents, Jocoi involved a collaboration with an Austrian self-help group for affected parents. The stories...

Relationship Between Depression and Perception of Pain Severity in Patients Admitted to General Surgery Ward

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Mehdi Samadzadeh

2016-11-01

Full Text Available Background Depression is considered as the most common psychological problem in individuals. Patients with persistent pain usually suffer from depression, disturbance in interpersonal relations, fatigue, and reduced physical and psychological performance. Objectives The aim of this study was to survey the relationship between depression and perception of pain severity in patients admitted to general surgery ward. Methods This research was a cross-sectional descriptive study. The study population included patients admitted to general surgery ward at hospitals of Ardabil city during 2010 - 2011. The study sample consisted of 168 individuals (male and female who were selected by nonrandomized convenience sampling method. The data were collected using a questionnaire on demographic information, the Beck depression inventory (BDI, and Toren questionnaire on pain beliefs and perceptions. The SPSS software was used for statistical analysis. Results The highest frequency of participants had moderate depression (44.1% while the lowest frequency belonged to healthy individuals (4.2%. The score of depression was higher in men (23.21 ± 7.56 than women (19.19 ± 6.84 as the same as the score of pain perception (8.91 ± 2.34 vs. 7.95 ± 1.87, respectively. The results indicated that there was a positive significant relationship between depression and perception of pain severity (P ≤ 0.01. This means that patients who have a history of depression feel much more pain during hospitalization and after the surgery. Conclusions Depressed or anguished patients report more pain compared to healthy ones.

Predictors of Complicated Grief after a Natural Disaster: A Population Study Two Years after the 2004 South-East Asian Tsunami

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Kristensen, Pal; Weisaeth, Lars; Heir, Trond

2010-01-01

The authors examined predictors of complicated grief (CG) in Norwegians 2 years after bereavement in the 2004 South-East Asian tsunami. A cross-sectional postal survey retrospectively covering disaster experiences and assessing CG according to the Inventory of Complicated Grief yielded 130 respondents (35 directly disaster-exposed and 95 not…

Strengthening Grief Support for Adolescents Coping with a Peer's Death

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Balk, David E.; Zaengle, Donna; Corr, Charles A.

2011-01-01

This article offers suggestions for strengthening school-based grief support following an adolescent's death. Such interventions must be considered within the context of: (a) development during adolescence; (b) the role of peers in adolescent development; and (c) the fact that an adolescent peer's death is a non-normative life crisis in developed…

Acknowledging sexual bereavement: a path out of disenfranchised grief.

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Radosh, Alice; Simkin, Linda

2016-11-01

Despite increasing awareness of the importance of sexuality for older adults, research and popular literature rarely acknowledge what we term "sexual bereavement" - mourning the loss of sexual intimacy when predeceased. The reluctance to acknowledge sexual bereavement may create "disenfranchised grief" leaving the bereaved unsupported in coping with this aspect of mourning. This preliminary study focuses on women in the United States and sought to determine whether they anticipate missing sex if predeceased, whether they would want to talk about this loss, and identified factors associated with communicating about sexual bereavement. Findings from our survey of 104 women, 55 years and older, most of whom were heterosexual, revealed that a large majority (72%) anticipates missing sex with their partner and 67% would want to initiate a discussion about this. An even higher percentage would want friends to initiate the topic. Yet, 57% of participants report it would not occur to them to initiate a discussion with a widowed friend about the friend's loss. Disenfranchised grief can have negative emotional and physical consequences. This paper suggests a role for friends and professionals in addressing this neglected issue. Copyright © 2016 Elsevier Inc. All rights reserved.

Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11.

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Holly G Prigerson

2009-08-01

Full Text Available Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction.A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment.The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11. Please see later in the article for Editors' Summary.

Complicated grief and manic comorbidity in the aftermath of the loss of a son.

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Carmassi, Claudia; Shear, M Katherine; Socci, Chiara; Corsi, Martina; Dell'osso, Liliana; First, Michael B

2013-09-01

Based on the recommendations of the sub-workgroup on trauma and dissociative disorders, the American Psychiatric Association (APA) removed the "bereavement exclusion" from the criteria for major depression in DSM-5. In addition, proposed DSM-5 research criteria for persistent complex bereavement disorder (PCBD) were included in the new manual in a section for conditions and criteria needing further research. We describe a case that warranted such a diagnosis. The patient was a 52- year-old woman who was admitted to the inpatient unit of our clinic on the birthday of her son who had died 18 months earlier. She was diagnosed with a manic episode with psychotic symptoms according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria and was treated accordingly. Three months after discharge, she made a suicide attempt and was admitted and re-assessed. During this admission, she completed the Inventory of Complicated Grief (ICG), the Mood-Spectrum Rating Scale (MOODS-SR), and the Trauma and Loss Spectrum questionnaire (TALS-SR). She endorsed symptoms of intense yearning for her son, feelings of shock and disbelief, anger and bitterness related to his death, estrangement from others, auditory, tactile and visual hallucinations of the deceased, and intense emotional reactivity to memories of her son. These symptoms were sufficiently prolonged and severe to meet criteria for complicated grief. While complicated grief appeared to be the primary diagnosis for this patient, when she was diagnosed using only DSMIV-TR criteria, her treatment failed to address herprimary problem. This case draws attention to the occurrence of manic-like symptoms as well as depression-like manifestations following bereavement and highlights the importance of including the syndrome of complicated grief in the diagnostic nomenclature.

"Prolonged grief disorder" and "persistent complex bereavement disorder", but not "complicated grief", are one and the same diagnostic entity : an analysis of data from the Yale Bereavement Study

NARCIS (Netherlands)

Maciejewski, Paul K; Maercker, Andreas; Boelen, Paul A|info:eu-repo/dai/nl/174011954; Prigerson, Holly G

2016-01-01

There exists a general consensus that prolonged grief disorder (PGD), or some variant of PGD, represents a distinct mental disorder worthy of diagnosis and treatment. Nevertheless, confusion remains over whether different names and proposed symptom criteria for this disorder identify the same or

Helping parents live with the hole in their heart: The role of health care providers and institutions in the bereaved parents' grief journeys.

Science.gov (United States)

Snaman, Jennifer M; Kaye, Erica C; Torres, Carlos; Gibson, Deborah V; Baker, Justin N

2016-09-01

Bereaved parents experience significant psychosocial and health sequelae, suggesting that this population may benefit from the ongoing extension of support and resources throughout the grief journey. The interaction of hospital staff with patients and families at the end of a child's life and after death profoundly affects parental grief, offering a unique opportunity for the medical community to positively impact the bereavement experience. The current study was conducted to explore the role of the health care team and medical institutions in the grief journeys of parents whose child died a cancer-related death. Eleven bereaved parents participated in 2 focus groups. Responses to each of the 3 main prompts were coded and analyzed independently using semantic content analysis techniques. Four main concepts were identified within the parental narratives, including the importance of strong and ongoing relationships between providers and bereaved families, the importance of high-quality communication, the effect of negative experiences between providers and families on parental grief, and the importance of the institution's role in the grief journeys of bereaved parents. Bereaved parents consistently identified the critical role played by medical staff and medical institutions throughout the grief journey. Key components of bereavement support identified by parents should serve to guide the actions of providers as well as provide a template for the development of a comprehensive bereavement program within an institution. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2757-2765. © 2016 American Cancer Society. © 2016 American Cancer Society.

Depression or Grief? The Experience of Caregivers of People with Dementia.

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Walker, Rebecca J.; Pomeroy, Elizabeth C.

1996-01-01

Study of caregivers of people with dementia suggests that the depression so frequently described in the literature may not be as severe or clinically significant as previously thought and may be described as anticipatory grief. Results may assist practitioners in planning and evaluating the effectiveness of clinical interventions. (RJM)

Immigrants Coping with Transnational Deaths and Bereavement: The Influence of Migratory Loss and Anticipatory Grief.

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Nesteruk, Olena

2017-12-14

This study examines immigrants' experiences of bereavement and coping with the deaths of family members in a transnational context. Data were collected through in-depth personal interviews with middle-aged and older immigrants from different countries of origin, who have been living in the United States for a majority of their adult lives. Thematic analysis of participants' narratives showed that immigrants' geographic distance from family complicated caregiving circumstances and rituals surrounding burial, and impacted the grieving process. At the same time, this distance also served as an emotional barrier and provided protection from prolonged grief. Immigrants' U.S.-based family and work responsibilities served as buffers from prolonged grief. Over time, immigrants became Americanized in their attitudes toward coping with death and favored a fast return to productive activities. Finally, immigrants' experience of migratory loss and anticipatory grief early in immigration, along with their personal growth and resilience developed over time, impacted their bereavement experiences later in life. Considering the limitations and the exploratory nature of the present study, further research is needed to investigate the specifics of coping with loss and bereavement among immigrants. © 2017 Family Process Institute.

Online Structured Writing Therapy for Post-traumatic Stress Disorder and Complicated Grief

NARCIS (Netherlands)

Ruwaard, J.; Lange, A.; Lindefors, N.; Andersson, G.

2016-01-01

Post-traumatic stress disorder (PTSD) and complicated grief are related disorders for which well-described and effective cognitive-behavioural therapeutic procedures exist that are firmly rooted in theoretical work. As a result, several research groups have been able to successfully translate these

Somatic expressions of grief and psychosomatic illness in the works of William Shakespeare and his coevals.

Science.gov (United States)

Heaton, Kenneth W

2012-10-01

To find out if Shakespeare, famed for his insights into human nature, is exceptional in how much his characters express grief through somatic symptoms and signs, and by physical illness. The texts of all large-scale works currently attributed to Shakespeare (39 plays, 3 long narrative poems) were systematically searched for bodily changes and for evidence of grief as dominating the character's emotional state at the time. The findings were compared with those from a search of 46 works, similar in genre, by 15 prominent playwrights active at the same time as Shakespeare. In Shakespeare 31 different grief-associated symptoms or signs were found, in 140 instances. They are present in all but two of his plays and long poems and involve most systems of the body. With non-Shakespearean writers there were 26 kinds, 132 instances. Twenty-two changes are common to both groups, including fainting, death (sudden or after a decline), and wrinkled face, and symptoms such as malaise, fatigue, awareness of the heart-beat, and anorexia. Ten somatic expressions of grief were found only in Shakespeare, including hyperventilation, hair turning white and premature childbirth. Four were found only in his contemporaries but were trivial or unconvincing. Deaths and non-fatal illnesses are prevalent in Shakespeare. Grieving Shakespearean characters exhibit many somatic symptoms and signs and a wide range of psychosomatic illnesses. This panoply of psychosomatic phenomena may be an artistic artefact but it also confirms that Shakespeare's empathy with grieving humanity was unrivalled. Copyright © 2012 Elsevier Inc. All rights reserved.

The existential realities of grief and bereavement

DEFF Research Database (Denmark)

Køster, Allan; Winther-Lindqvist, Ditte

Our poster outlines the basic analytical and methodological strategy of a pending 3-year investigation into the existential dimensions of grief. The project is divided into two main foci: 1) a retrospective investigation into how bereavement of a parent in childhood/adolescence shapes the various....... Methodologically our design stands out by including a strong focus on the embodied and prereflective dimension of personal existences and connecting this with narrative accounts. The theoretical basis for this approach has been presented in recent publications by the authors (Køster & Winther-Lindqvist 2017...... and Køster 2016, 2017) and will be explicated in the poster session....

Dream Content in Complicated Grief: A Window into Loss-Related Cognitive Schemas

Science.gov (United States)

Germain, Anne; Shear, Katherine M.; Walsh, Colleen; Buysse, Daniel J.; Monk, Timothy H.; Reynolds, Charles F., III; Frank, Ellen; Silowash, Russell

2013-01-01

Bereavement and its accompanying psychological response (grief) constitute potent experiences that necessitate the reorganization of cognitive-affective representations of lost significant attachment figures during both wakefulness and dreaming. The goals of this preliminary study were to explore whether the dream content of 77 adults with…

Let me hear of your mercy in the mourning: forgiveness, grief, and continuing bonds.

Science.gov (United States)

Gassin, Elizabeth A; Lengel, Gregory J

2014-01-01

Clarity about the utility of continuing bonds (CB) continues to be evasive in the research. In 2 different correlational studies, the authors explored the relationship between CB and 2 other variables: 1 representing mental health (forgiveness of the deceased) and the other representing psychological distress (prolonged grief). Although researchers have addressed the latter relationship in the literature, assessing the relationship between CB and forgiveness has not been undertaken. Results suggest that forgiveness in general, and affective aspects of forgiveness in particular, predict psychological forms of CB. Results related to grief depended on how CB was assessed. These findings provide evidence of the relative health of certain types of relationship with deceased persons and also suggest that forgiveness interventions may be a way of promoting such healthy bonds.

Grief Interrupted: The Experience of Loss Among Incarcerated Women

OpenAIRE

Harner, Holly M.; Hentz, Patricia M.; Evangelista, Maria Carmela

2010-01-01

Incarcerated women face a number of stressors apart from the actual incarceration. Nearly half of all women in prison experience the death of a loved one during their incarceration. Our purpose for this study was to explore the experience of grief and loss among incarcerated women using a phenomenological method. Our study approach followed van Manen's method of phenomenology and Munhall's description of existential lifeworlds. Our analysis revealed four existential lifeworlds: temporality: f...

Family focused grief therapy: The therapy of choice in palliative care

Directory of Open Access Journals (Sweden)

Klikovac Tamara

2017-01-01

Full Text Available Palliative care refers to offering physical, psychosocial and spiritual care to patients who are suffering from life threatening diseases. It also includes providing psychological support for family members and other close relations during the period of illness (anticipatory grief and in the period of bereavement and mourning after the patient's death. The choice of therapy during the process of bereavement and mourning is Family Focused Grief Therapy (FFGT. FFGT is a brief, focused and time-limited psychotherapeutic model of intervention belonging to family psychotherapy which is specified for the families that face a life threatening disease of a family member. FFGT, with some modifications, can be applied in work with the families who are facing a terminal illness of younger family members - a child or an adolescent. FFGT typically comprises of 7 to 9 sessions lasting for 90 minutes, which are arranged flexibly across 9 to 18 months, depending on the needs of each family individually. It is important to emphasize that the frequency and number of sessions in each phase depend on the specific features and needs of each particular family. The intervention aim of FFGT is to prevent the complications of bereavement by enhancing the functioning of the family, through exploration of its cohesion, communications (of thoughts and feelings, and handling of conflict. The story of illness and the related grief is shared in the process. The creator of this model is Dr David Kissane, a psychiatrist and a family psychotherapist from Melbourne, Australia, who also worked at the Memorial Sloan Kettering Cancer Centre in New York. The main aims of this article are, on the one hand, to introduce this very useful model of the family therapy to the professional community in Serbia and, on the other, to introduce a conceptual and practical frame of palliative care.

Abuse, Maltreatment and PTSD and Their Relationship to Migraine

Science.gov (United States)

... pain, injury, or mental anguish. Examples: neglect, threats, harassment, controlling behavior, attempts to isolate and bullying. Sexual ... Institute of Medical Research, Adjunct Clinical Professor, Jefferson School of Medicine Dawn C. Buse, PhD, Director of ...

Size acceptance as a grief process: observations from psychotherapy with lesbian feminists.

Science.gov (United States)

Courtney, Jeanne

2008-01-01

Based on observations from my psychotherapy practice, I apply Kubler-Ross' five stages of grief (denial, anger, bargaining, depression, and acceptance) to the process a woman goes through when she learns about size acceptance and lets go of the unrealistic wish to make her body size conform to fat-phobic societal ideals of female beauty. Clients' presentations, therapeutic interventions, and countertransference are discussed for each stage. Lesbian feminists are likely to embrace size acceptance politics but may retain negative feelings about their own body size. In the bargaining stage, they may confound health concerns with body image issues, and it is important in their therapy to provide a holding environment that can tolerate ambivalence. My own depression stage was marked by countertransference that caused me to avoid the topic of body image with my clients. Therapists can help women in the size acceptance grief process by exploring their own evolving feelings about body image, bringing up the topic, and providing a non-judgmental holding environment.

College Students' Grief and Coping Strategies in Bereavement and Separation

OpenAIRE

Nakajima, Naomi; Kodama, Kenichi

2013-01-01

The purposes of this study are to clarify the characteristics of college students' bereavement and separation and the relationship between coping strategies and grief reactions in bereavement and separation. 212 college students completed questionnaires. The results indicated that the majority of the respondents have experienced some bereavement or separation, in particular, separation from the lover. Multiple regression analyses showed that coping strategies such as "avoidance", "abandonment...

Prolonged grief and depression after unnatural loss : Latent class analyses and cognitive correlates

NARCIS (Netherlands)

Boelen, Paul A; Reijntjes, Albert; J Djelantik, A A A Manik; Smid, Geert E

2016-01-01

This study sought to identify (a) subgroups among people confronted with unnatural/violent loss characterized by different symptoms profiles of prolonged grief disorder (PGD) and depression, and (b) socio-demographic, loss-related, and cognitive variables associated with subgroup membership. We used

Maladaptive coping in adults who have experienced early parental loss and grief counseling

DEFF Research Database (Denmark)

Høeg, Beverley Lim; Appel, Charlotte W.; von Heymann-Horan, Annika B.

2017-01-01

bereaved adults who received grief counseling (N = 822 women, N = 190 men) with bereaved controls who had not (N = 233 women, N = 66 men). Bereaved adults reported significantly more substance use, behavioral disengagement, and emotional eating than non-bereaved adults. Counseling participants reported...

A fobia e o pânico em suas relações com a angústia Phobia and panic related to anguish

Directory of Open Access Journals (Sweden)

Vera Lopes Besset

1999-08-01

Full Text Available Nesse texto, objetivou-se indicar as relações da angústia com as manifestações patológicas da fobia e do pânico, demonstrando a adequação da proposta de intervenção terapêutica, dentro de uma perspectiva psicanalítica. Esse trabalho se refere a resultados parciais de pesquisa teórica sobre a angústia, onde o método utilizado é o de análise crítica dos conceitos. Neste, buscamos investigar a coerência entre as formulações teóricas de S. Freud e J. Lacan, já clássicas, com o que se observa na clínica hoje. Para tanto, valemo-nos da referência a dados da experiência clínica. A investigação aponta para a adequação da concepção psicanalítica da fobia e do pânico, pois confirma o caráter de substituto que tem o objeto temido. É esta mesma natureza que o torna permeável à ação da fala, no dispositivo de linguagem que é o da clínica psicanalítica.The paper seeks to point out the relationship between anguish and the pathological manifestations of phobia and panic, and to demonstrate the adequacy of a proposal of therapeutic intervention within a psychoanalytical perspective. It reflects the parcial results of a theoretical research on anguish based on the formulations of Freud and Lacan. It is also reflexive of observations derived from present-day clinical practice. To this, data of clinic experience were used as reference. The results point to the usefulness of the psychoanalytic notion of phobia and panic since they confirm that the object of fear has a nature of substitute. This very nature makes the object fear permeable to the action of speech within the language device of the psychoanalytic clinic.

Long-term effects of the Family Bereavement Program on spousally bereaved parents: Grief, mental health problems, alcohol problems, and coping efficacy.

Science.gov (United States)

Sandler, Irwin; Tein, Jenn-Yun; Cham, Heining; Wolchik, Sharlene; Ayers, Tim

2016-08-01

This study reports on the findings from a 6-year follow-up of a randomized trial of the Family Bereavement Program (FBP) on the outcomes for spousally bereaved parents. Spousally bereaved parents (N = 131) participated in the trial in which they were randomly assigned to receive the FBP (N = 72) or literature control (N = 59). Parents were assessed at four time points: pretest, posttest, and 11-month and 6-year follow-up. They reported on mental health problems, grief, and parenting at all four time periods. At the 6-year follow-up, parents reported on additional measures of persistent complex bereavement disorder, alcohol abuse problems, and coping efficacy. Bereaved parents in the FBP as compared to those in the literature control had lower levels of symptoms of depression, general psychiatric distress, prolonged grief, and alcohol problems, and higher coping efficacy (for mothers) at the 6-year follow-up. Multiple characteristics of the parent (e.g., gender, age, and baseline mental health problems) and of the spousal death (e.g., cause of death) were tested as moderators of program effects on each outcome, but only 3 of 45 tests of moderation were significant. Latent growth modeling found that the effects of the FBP on depression, psychiatric distress, and grief occurred immediately following program participation and were maintained over 6 years. Mediation analysis found that improvement in positive parenting partially mediated program effects to reduce depression and psychiatric distress, but had an indirect effect to higher levels of grief at the 6-year follow-up. Mediation analysis also found that improved parenting at the 6-year follow-up was partially mediated by program effects to reduce depression and that program effects to increase coping efficacy at the 6-year follow-up was partially mediated through reduced depression and grief and improved parenting. FBP reduced mental health problems, prolonged grief, and alcohol abuse, and increased coping

Rural health professionals' perspectives on providing grief and loss support in cancer care.

Science.gov (United States)

Breen, L J; O'Connor, M

2013-11-01

Research demonstrates considerable inequalities in service delivery and health outcomes for people with cancer living outside large metropolitan cities. Semi-structured interviews with 11 professionals providing grief and loss support for people with cancer and their families in rural, regional, and remote areas Western Australia revealed the challenges they faced in delivering such support. The data are presented in four themes - Inequity of regional versus metropolitan services, Strain of the 'Jack of all trades' role, Constraints to accessing professional development, and Challenges in delivering post-bereavement services. These challenges are likely to be of growing concern given that populations are declining in rural areas as Australia becomes increasingly urban. The findings have implications in enhancing the loss and grief support services available in rural, regional, and remote Western Australia, including those grieving the death of a loved one through cancer. © 2013 John Wiley & Sons Ltd.

Art Therapy Applications of Dolls in Grief Recovery, Identity, and Community Service

Science.gov (United States)

Feen-Calligan, Holly; McIntyre, Barbara; Sands-Goldstein, Margaret

2009-01-01

This article reviews the history of dollmaking that is relevant to art therapy, and the application of dolls as therapeutic media in clinical and educational settings. The authors describe their experiences using dollmaking in the resolution of grief, in professional identity construction, and in community service. The article addresses the…

Understanding Parental Grief as a Response to Mental Illness: Implications for Practice

Science.gov (United States)

Penzo, Jeanine A.; Harvey, Pat

2008-01-01

Parents who are raising children with mental illness struggle with feelings of grief and loss. Kubler-Ross' (1969) stages of grieving (denial, anger, bargaining, depression, and acceptance) are examined as experienced by parents raising children with chronic mental illness. Practice implications for social workers who are working with children and…

Complicated grief in Aboriginal populations.

Science.gov (United States)

Spiwak, Rae; Sareen, Jitender; Elias, Brenda; Martens, Patricia; Munro, Garry; Bolton, James

2012-06-01

To date there have been no studies examining complicated grief (CG) in Aboriginal populations. Although this research gap exists, it can be hypothesized that Aboriginal populations may be at increased risk for CG, given a variety of factors, including increased rates of all-cause mortality and death by suicide. Aboriginal people also have a past history of multiple stressors resulting from the effects of colonization and forced assimilation, a significant example being residential school placement. This loss of culture and high rates of traumatic events may place Aboriginal individuals at increased risk for suicide, as well as CG resulting from traumatic loss and suicide bereavement. Studies are needed to examine CG in Aboriginal populations. These studies must include cooperation with Aboriginal communities to help identify risk factors for CG, understand the role of culture among these communities, and identify interventions to reduce poor health outcomes such as suicidal behavior.

A critical and interpretive literature review of birthing women's non-elicited pain language.

Science.gov (United States)

Power, Stephanie; Bogossian, Fiona E; Sussex, Roland; Strong, Jenny

2017-10-01

Standardised pain assessment i.e. the McGill Pain Questionnaire provide an elicited pain language. Midwives observe spontaneous non-elicited pain language to guide their assessment of how a woman is coping with labour. This paper examined the labour pain experience using the questions: What type of pain language do women use? Do any of the words match the descriptors of standardised pain assessments? What type of information doverbal and non-verbal cues provide to the midwife? A literature search was conducted in 2013. Studies were included if they had pain as the primary outcome and examined non-elicited pain language from the maternal perspective. A total of 12 articles were included. The analysis revealed six categories in which labour pain can be viewed: 'positive', 'negative', 'physical', 'emotional', 'transcendent' and 'natural'. Women's language comprised i.e. prefixes and suffixes, which indicate the qualities of pain, and figurative language. Language indicated location of pain, gave insight into other life phenomena i.e. death, and shared similarities with standardised pain assessmentdescriptors. Labour cues were 'functional', 'dysfunctional,' or 'neutral' (part of the physiological childbirth process), and were verbal, non-verbal, emotional, psychological, physical behaviour or reactions, or tactile. Labour can bring about a spectrum of sensations and therefore emotions from happiness and pleasure to suffering and grief. Spontaneous pain language comprises verbal language and non-verbal behaviour. Narratives are an effective form of pain communication in that they provide details regarding the quality, nature and dimensions of pain, and details notcaptured in quantitative data. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Mourning Child Grief Support Group Curriculum: Early Childhood Edition, Kindergarten-Grade 2.

Science.gov (United States)

Lehmann, Linda; Jimerson, Shane R.; Gaasch, Ann

The Mourning Child Early Childhood grief support curriculum is intended for use with early elementary-aged children, specifically children in kindergarten through grade two, who have experienced the death of someone special to them. It is designed for use by professionals who work in schools, hospitals, hospices, mental health agencies, or any…

Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief.

Science.gov (United States)

Lafarge, Caroline; Mitchell, Kathryn; Fox, Pauline

2017-09-01

Research about termination for fetal abnormality (TFA) suggests that it is a traumatic event with potential negative psychological consequences. However, evidence also indicates that following traumatic events individuals may experience growth. Although TFA's negative psychological outcomes are well documented, little is known of the potential for growth following this event. Therefore, the study's objectives were to measure posttraumatic growth (PTG) post-TFA, examine the relationship between PTG, perinatal grief and coping, and determine the predictors of PTG. An online, retrospective survey was conducted with 161 women. Eligible participants were women over 18 who had undergone TFA. Participants were recruited from a support organisation. They completed the Brief COPE, Short Perinatal Grief Scale and Posttraumatic Growth Inventory. Data were analysed using regression analyses. Moderate levels of PTG were observed for "relating to others," "personal strengths" and "appreciation of life." "Positive reframing" was a significant predictor of PTG. Despite using mainly "adaptive" coping strategies, women's grief levels were high. "Adaptive" coping strategies such as, "positive reframing" are relevant to TFA. They may act as protective factors against distress and as foundations for growth, implicating that interventions such as Cognitive Behavioural Therapy, which aim to reframe women's experience, may be beneficial.

Factors Associated with Complicated Grief in Students Who Survived the Sewol Ferry Disaster in South Korea.

Science.gov (United States)

Lee, So Hee; Nam, Hee Sun; Kim, Hak Beom; Kim, Eun Ji; Noh, Jin-Won; Chae, Jeong-Ho

2018-03-01

The Sewol ferry disaster caused shock and grief in South Korea. The aim of this study was to identify the factors associated with symptoms of complicated grief (CG) among the surviving students 20 months after that disaster. This study was conducted using a cross-sectional design and a sample of 57 students who survived the Sewol ferry disaster. Data were collected using the following instruments: Inventory of Complicated Grief (ICG), the Lifetime Incidence of Traumatic Events-Child, the Child Report of Post-Traumatic Symptoms (CROPS), KIDSCREEN-27, Family Adaptability and Cohesion Evaluation Scales-III, the Peri-traumatic Dissociation-Post-traumatic Negative Beliefs-Post-traumatic Social Support scale, and the Strengths and Difficulties Questionnaire. A generalized linear model using a log link and Poisson distribution was performed to identify factors associated with symptoms of CG. The mean score on the ICG was 15.57 (standard deviation: 12.72). Being born in 1999, a higher score on the CROPS and a lower score in autonomy and relationship with parents on the KIDSCREEN-27 were related to higher levels of CG. Twenty months after the Sewol ferry disaster, 24.5% of surviving students were suffering from CG. This study uncovered a vulnerable population of bereaved children at high risk for CG.

Mourning Child Grief Support Group Curriculum: Middle Childhood Edition, Grades 3-6.

Science.gov (United States)

Lehmann, Linda; Jimerson, Shane R.; Gaasch, Ann

The Mourning Child Early Childhood grief support curriculum is intended for use with late elementary and middle school-aged children, specifically children in grades three through six, who have experienced the death of someone special to them. It is designed for use by professionals who work in schools, hospitals, hospices, mental health agencies,…

The utilisation of storytelling as a therapeutic intervention by educational psychologists to address behavioural challenges relating to grief of adolescent clients

OpenAIRE

2014-01-01

M.Ed. (Educational Psychology) Storytelling as a therapeutic intervention entails the narrating of events by externalising emotions, thoughts and responses to life-changing events such as loss and grief. This creates the opportunity for clients to engage with psychologists by projecting various beliefs and challenges, such as grief, through a range of therapeutic modalities. This study conducts an inquiry into the ways in which storytelling can be utilised by educational psychologists with...

Cautioning Health-Care Professionals : Bereaved Persons Are Misguided Through the Stages of Grief

NARCIS (Netherlands)

Stroebe, Margaret; Schut, Henk; Boerner, Kathrin

2017-01-01

Science and practice seem deeply stuck in the so-called stage theory of grief. Health-care professionals continue to "prescribe" stages. Basically, this perspective endorses the idea that bereaved people go through a set pattern of specific reactions over time following the death of a loved one. It

A pilgrimage into the liminal: an experiential enquiry into the psychological and embodied space of grief and its representation in film

OpenAIRE

Lovey, Christina

2016-01-01

The lived experience of grief is a universal phenomenon that is both a psychological and embodied experience; it finds expression in varying art forms and is considered in multiple discourses, including psychoanalysis. This project identifies a range of responses to loss and grief and critically reflects on their value and efficacy. Through the use of a phenomenological research process, that results in the production of filmworks, the value of using film as a way of managing and processing...

Growing up with grief: revisiting the death of a parent over the life course.

Science.gov (United States)

Blank, Nancee M; Werner-Lin, Allison

2011-01-01

In the era of managed care, evidence-based practice, and short term, solution focused interventions, clinicians in agency based settings generally do not have the luxury of long-term contact with bereaved children. Although a substantial, yet controversial, literature argues that children cannot fully resolve early loss until adulthood, limited attention is given to how children's understandings of early loss shift as their cognitive capacities mature. This article argues the emotional experience of grief shifts: 1) as children grapple with both normative life changes and the tasks of mourning, and 2) as their cognitive and emotional development allow them to understand and question aspects of their deceased parent's life and death in new ways. This article will present an overview of longitudinal and cross-sectional research on the long-term impact of childhood grief. We then suggest the ways bereaved children and adolescents revisit and reintegrate the loss of a parent as their emotional, moral, and cognitive capacities mature and as normative ego-centrism and magical thinking decline. To demonstrate these ideas, we draw on the case of a parentally bereaved boy and his family presenting across agency-based and private-practice work over the course of 14 years. This case suggests the need for coordinated care for children who are moving beyond the initial trauma of parental loss into various stages of grief and reintegration. While the loss of a parent is permanent and unchanging, the process is not: it is part of the child's ongoing experience. (Worden, 1996, p. 16).

Self-compassion, grief rumination, and psychopathology among relatives of missing persons : A mediation analysis

NARCIS (Netherlands)

Lenferink, Lonneke I.M.; Eisma, Maarten C.; de Keijser, Jos; Boelen, Paul A.

2017-01-01

Abstract Introduction Experiencing the disappearance of a loved one is a unique type of loss that may heighten the risk of developing prolonged grief (PG), depression, and posttraumatic stress (PTS) symptoms. Little is known about protective and risk factors for psychopathology among relatives of

The bereavement process of tissue donors' family members: responses of grief, posttraumatic stress, personal growth, and ongoing attachment.

Science.gov (United States)

Hogan, Nancy; Schmidt, Lee; Coolican, Maggie

2014-09-01

Donated tissues can save lives of critically burned patients and those needing a heart valve replacement. Tissues enhance the lives of a million recipients annually through transplants of corneas, bones, tendons, and vein grafts. Unfortunately, the need for some tissues exceeds their availability. The goal of the quantitative component of this mixed methods study was to identify the grief, posttraumatic stress, personal growth, and ongoing attachment response of tissue donors' family members during a 2-year period. Simultaneous mixed methods design. The sample for this study consisted of 52 tissue donors' family members, mostly widows (83%). Data were collected for 2 years to test changes in grief, posttraumatic stress, panic behavior, personal growth, and ongoing attachment. The bereaved participants experienced significantly fewer grief reactions, less posttraumatic stress, and greater personal growth. There was no significant difference in the ongoing attachment to their deceased loved ones. The results of this study may reinforce the positive meaning that tissue donors' family members can find in tissue donation. Findings also demonstrate that the bereavement process corroborates contemporary bereavement and attachment theories. Health professionals are encouraged to seek donations with less worry that tissue donors' family members will experience adverse outcomes during bereavement.

Suicide Survivors' Mental Health and Grief Reactions: A Systematic Review of Controlled Studies

Science.gov (United States)

Sveen, Carl-Aksel; Walby, Fredrik A.

2008-01-01

There has been a debate over several decades whether suicide survivors experience more severe mental health consequences and grief reactions than those who have been bereaved through other causes of death. This is the first systematic review of suicide survivors' reactions compared with survivors after other modes of death. Studies were identified…

The relative importance of avoidance and restoration-oriented stressors for grief and depression in bereaved parents.

Science.gov (United States)

Harper, Mairi; O'Connor, Rory C; O'Carroll, Ronan E

2015-01-01

Previous research has identified a number of individual risk factors for parental bereavement including the sex of the parent, the sex of the child, avoidance-focussed coping style and time since death. These factors emerged from research where variables were tested univariately and their relative importance is currently unknown. The current research, therefore, aims to investigate which risk factors are important, multivariately, for the outcomes of grief and depression in parents following the death of their child. Psychosocial measures were completed by 106 bereaved parents four years post-loss, recruited from death records in Scotland. The cause of the child's death included long-term illness and stillbirths as well as sudden and violent deaths. In multivariate regression analyses, depression was predicted by higher avoidance-focussed coping and higher number of restoration-oriented stressors such as relationship difficulties, problems at work and financial issues. Grief was predicted by higher avoidance, restoration stressors and level of continuing bonds. The present study adds to the knowledge about the phenomenon of parental bereavement with participants recruited directly from death records rather than through support, clinical or obituary sources. Factors previously found to be associated with outcomes when tested univariately such as sudden, violent death or sex of the parent were not significant when tested multivariately. This study highlights that different vulnerability factors exist for grief and depression in bereaved parents.

Advanced Cancer Patients' Perceptions of Dignity: The Impact of Psychologically Distressing Symptoms and Preparatory Grief.

Science.gov (United States)

Kostopoulou, Sotiria; Parpa, Efi; Tsilika, Eleni; Katsaragakis, Stylianos; Papazoglou, Irene; Zygogianni, Anna; Galanos, Antonis; Mystakidou, Kyriaki

2018-04-01

The present study assesses the relationship between patient dignity in advanced cancer and the following variables: psychological distress, preparatory grief, and sociodemographic and clinical characteristics. The sample consisted of 120 patients with advanced cancer. The self-administered questionnaires were as follows: the Preparatory Grief in Advanced Cancer Patients (PGAC), the Patient Dignity Inventory-Greek (PDI-Gr), the Greek Schedule for Attitudes toward Hastened Death (G-SAHD), and the Greek version of the Hospital Anxiety and Depression Scale (G-HADS). Moderate to strong statistically significant correlations were found between the 4 subscales of PDI-Gr (psychological distress, body image and role identity, self-esteem, and social support) with G-HADS, G-SAHD, and PGAC ( P dignity among patients with advanced cancer. Clinicians should assess and attend to dignity-distressing factors in the care of patients with advanced cancer.

Emotional response patterns of depression, grief, sadness and stress to differing life events: a quantitative analysis.

Science.gov (United States)

Parker, Gordon; Paterson, Amelia; Hadzi-Pavlovic, Dusan

2015-04-01

In clarifying the clinical definition of an episode of major depression, DSM-5 equates bereavement with a number of other loss-related stressors (e.g. financial ruin, serious medical problems) and infers differences between such loss-related and non-loss-related responses. We undertook a study with the aim of examining the likelihood of varying life stressors leading to depression or to other emotional responses, and so allowing consideration as to whether bereavement might be equivalent to other loss-related stressful triggers. We studied a sample comprising sub-sets of those likely to have either experienced or never experienced a clinical depressive episode and report data for both the whole sample and the separate sub-sets. Participants were asked to report their exposure to 16 differing stressors and, given definitions of depression, grief, sadness and stress, to rate (in order of importance) their primary and secondary reactions if so experienced. Only one event (i.e. the individual being left by their partner) generated depression as the most likely response within the sample. A grief reaction was nominated as the most likely primary response to the death of a first-degree relative (52%) and was also a relatively common primary response to the death of a more distant relative or close family friend (36%). While one-fourth (24%) nominated grief as the primary response to being left by one's partner, it was rarely nominated as a primary response to all other events, including the DSM-5 'loss-related' exemplars of a financial crisis and of a medical illness (rates of 3% and 2%, respectively). As participants were given a definition of the emotional responses and candidate contexts, their responses may have been a reflection of the definitions provided. Additionally, a retrospective, self-report design was used which may have impacted on the veracity of responses. Findings position a grief response as showing relative specificity to bereavement events and that

The mourning before: can anticipatory grief theory inform family care in adult intensive care?

Science.gov (United States)

Coombs, Maureen A

2010-12-01

Although anticipatory grief is a much-debated and critiqued bereavement concept, it does offer a way of understanding and exploring expected loss that may be helpful in certain situations. In end-of-life care in adult intensive care units, families often act as proxy decision makers for patients in the transition from curative treatment efforts to planned treatment withdrawal. Despite there being a developed evidence base to inform care of families at this time, few of the clinical studies that provided this evidence were underpinned by bereavement theory. Focusing on end-of-life intensive care practices, this paper integrates work on anticipatory grief and family interventions to present a family-centred framework of care. Through this it is argued that the complex needs of families must be more comprehensively understood by doctors and nurses and that interventions must be more systematically planned to improve quality end-of-life care for families in this setting.

The grief experience of same-sex couples within an Irish context: tacit acknowledgement.

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Glackin, Michelle; Higgins, Agnes

2008-06-01

This study sought to explore the grief experience of same sex couples. To date, the majority of research in this area has focused on the bereavement experience of individuals whose partner has died from an AIDS/HIV-related illness. The research design used was descriptive exploratory. A multi-pronged sampling strategy was employed to generate participants. Seven people underwent in-depth interviews once the study had received ethical approval. Data were analysed by coding, comparing, and merging codes into higher order themes. Five themes subsequently emerged that captured the essence of the bereavement experience, namely:'tacit acknowledgement'; 'sculpting the distress'; 'multiple losses'; 'seeking support'; and 'journeying anew.' While not all bereaved gay or lesbian partners experience 'disenfranchized grief', particularly if their relationship with the deceased was not hidden, it is clear from the findings of this study that many of the participants did (Doka, 1989;Wallbank, 1998). Health care professionals need to consider their approach to people who identify themselves as gay or lesbian, if they are to provide support structures (formal and informal) to meet their unique needs.

The MM-CGI Cerebral Palsy: modification and pretesting of an instrument to measure anticipatory grief in parents whose child has cerebral palsy.

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Al-Gamal, Ekhlas; Long, Tony

2014-07-01

To establish the potential of a modified version of the MM-CGI Childhood Cancer to assess anticipatory grief in parents of children with cerebral palsy, to amend the existing scale for use with the specific patient group, to test the psychometric properties of the modified version (MM-CGI Cerebral Palsy) and to review the clinical potential of the new scale. Parents of children with cerebral palsy may experience reactions similar to parents of children with other enduring or life-limiting conditions, and anticipatory grief may be one such psychological reaction. While the burden of caring is sometimes balanced by positive perceptions of the child, which enhance coping ability, for many parents the outcome is damage to their physical and mental health and impaired family functioning. A cross-sectional, descriptive, correlational design. The MM-CGI Cerebral Palsy was administered in structured interviews with 204 parents. Standardised measures of caregivers' depression, stress and perceived social support were also administered. Mothers and fathers were recruited from healthcare centres and schools for special education. Cronbach's alpha was used to assess internal consistency, and Pearson's product-moment correlation was used to assess construct validity. The subscales were each found to measure a single dimension of anticipatory grief, and significant correlations were established with existing instruments. The instrument demonstrated excellent internal consistency reliability and good construct validity. The MM-CGI Cerebral Palsy could be useful for diagnosing anticipatory grief among parents of children with cerebral palsy. This preliminary work moves the programme on to testing in intervention studies. In the absence of an existing measure for the assessment of anticipatory grief, specifically in parents of children with cerebral palsy, the MM-CGI Cerebral Palsy could prove to be an effective assessment tool for clinicians and researchers. © 2013 John Wiley

Evaluating Referral, Screening, and Assessment Procedures for Middle School Trauma/Grief-Focused Treatment Groups

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Grassetti, Stevie N.; Williamson, Ariel A.; Herres, Joanna; Kobak, Roger; Layne, Christopher M.; Kaplow, Julie B.; Pynoos, Robert S.

2018-01-01

There is a need to delineate best practices for referring, assessing, and retaining students suspected of posttraumatic stress (PTS) and maladaptive grief (MG) in school-based treatment. Evidence-based risk-screening procedures should accurately include students who are appropriate for group treatment and exclude students who do not require…

Psychological and Physiological Responses to Depressed Others

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1995-08-18

psychological pain and anguish experienced by depressed persons and their families is underscored by the significant number of suicides related to...Statistical analyses were pertormed using the SPSS -X statistical package. These analyses included examination of the sex of target, affect of target, and sex

Developing a Blended Course on Dying, Loss, and Grief

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Kavanaugh, Karen; Andreoni, V. Ann; Wilkie, Diana J.; Burgener, Sandra; Buschmann, MaryBeth Tank; Henderson, Gloria; Hsiung, Yi-Fang Yvonne; Zhao, Zhongsheng

2010-01-01

An important component of end-of-life education is to provide health professionals with content related to dying, loss, and grief. The authors describe the strategies used to develop and offer a blended course (integration of classroom face-to-face learning with online learning) that addressed the sensitive and often emotional content associated with grieving and bereavement. Using Kolb’s experiential learning theory, a set of 4 online learning modules, with engaging, interactive elements, was created. Course evaluations demonstrated the success of the blended course in comparison to the traditional, exclusive face-to-face approach. PMID:19412055

Do Incarcerated Offenders Experience the Five Stages of Grief as Do Terminally Ill Patients?

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Pledger, Carolyn Brastow

1985-01-01

Examines Kubler-Ross' five stages of grief (denial, anger, bargaining, depression, acceptance) as they are experienced not by terminally ill persons, but by 20 criminal offenders and their families during incarceration. Concludes that shock of arrest and incarceration stimulates reactions similar to those of persons coping with terminal diagnosis.…

Grief, Anger, Social Action: Experiences of the Windsor Chapter, Mothers against Drunk Driving (MADD).

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Kroeker, B. J.; And Others

1994-01-01

The experiences of the Windsor, Ontario, Canada, chapter of Mothers Against Drunk Driving (MADD), in its development and progress through the grief-anger-social action continuum, are described. This article also portrays a model for problem resolution which emphasizes incorporating the respective strengths and efficiencies of self-help groups and…

Grief rumination mediates the association between self-compassion and psychopathology in relatives of missing persons

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Lenferink, Lonneke; Eisma, Maarten; de Keijser, Jos; Boelen, P.A.

2017-01-01

Background The disappearance of a loved one is a unique type of loss, also termed “ambiguous loss”, which may heighten the risk for developing prolonged grief (PG), depression, and posttraumatic stress (PTS) symptoms. Little is known about protective and risk factors for psychopathology among

Feelings of loss and grief in parents of children diagnosed with autism spectrum disorder (ASD).

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Fernańdez-Alcántara, Manuel; García-Caro, M Paz; Pérez-Marfil, M Nieves; Hueso-Montoro, Cesar; Laynez-Rubio, Carolina; Cruz-Quintana, Francisco

2016-08-01

Various authors have reported feelings of loss and grief in parents of children with autism spectrum disorder. However, no previous studies have investigated the structure of these feelings. To analyze in depth the feelings of loss in parents of children diagnosed with autism spectrum disorder. A qualitative study was conducted based on grounded theory. Twenty parents participated through purposive sampling. Semi-structured interviews were conducted, asking about different emotional aspects of the upbringing of a child with autism spectrum disorder. Atlas.ti 6.2 program was used for open, axial, and selective coding. The core category that explained the feelings of these parents was unexpected child loss, associated with shock, negation, fear, guilt, anger, and/or sadness. Two processes were identified, one associated with the resolution of grief and the other with obstacles to overcoming it. Feelings of loss play an important role in explaining the complex emotions experienced by these parents. Different intervention strategies are proposed. Copyright © 2016 Elsevier Ltd. All rights reserved.

A longitudinal study of the grief of mothers and fathers of children with intellectual disability.

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Bruce, E J; Schultz, C L; Smyrnios, K X

1996-03-01

As a follow-up to a single-point-in-time study which suggested support for the proposition that grieving is an ongoing feature of parenting children with intellectual disability, the present investigation reports findings based on annual interviews conducted over a three-year period. Longitudinal outcomes on measures used to define grief largely confirmed the original findings. Of particular interest were (a) indications of the presence of grief over time (b) the finding that the 49 mothers and 49 fathers report similar intensity of continued wishing for what might have been, and (c) the conclusion that the responses of the mothers on the Impact of Event Scale and to current levels of distress when thinking about time of diagnoses are significantly more intense than those of the fathers. Attention is drawn to patterns emerging from gender-related differences. Resulted are discussed within the framework of four mandates for research and practice, with particular reference to psycho-educational support through groupwork.

A Cognitive Attachment Model of prolonged grief: integrating attachments, memory, and identity.

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Maccallum, Fiona; Bryant, Richard A

2013-08-01

Prolonged grief (PG), otherwise known as complicated grief, has attracted much attention in recent years as a potentially debilitating condition that affects approximately 10% of bereaved people. We propose a model of PG that integrates processes of attachment, self-identity, and autobiographical memory. The paper commences with a discussion of the PG construct and reviews current evidence regarding the distinctiveness of PG from other bereavement related-outcomes. We then review the evidence regarding the dysfunctional attachments, appraisals, and coping styles that people with PG display. Recent evidence pertaining to the patterns of autobiographical memory in PG is described in the context of the self-memory system. This system provides a unifying framework to understand the roles of personal memories, identity, attachments, and coping responses in PG. The proposed model places emphasis on how one's sense of identity influences yearning, memories of the deceased, appraisals, and coping strategies, to maintain a focus on the loss. The model is discussed in relation to existing models of PG. The potential for shaping treatment strategies to shift perceptions of the self is then outlined. Finally, we outline future directions to test propositions stemming from the model and enhance our understanding of the mechanisms underlying PG. Copyright © 2013 Elsevier Ltd. All rights reserved.

"So truly afflicting and distressing to me his sorrowing mother": expressions of maternal grief in eighteenth-century Philadelphia.

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McMahon, Lucia

2012-01-01

In 1781, Lowry Wister produced an eight-page account of her three-year son’s death from small pox. Lowry Wister’s narrative offers important insights into the emotional landscape of mothering, mourning, and religion in late eighteenth-century America. Religious and cultural prescriptions stressed restraint throughout the mourning process, and in particular admonished women to avoid excessive displays of grief. Lowry Wister’s emotional struggles as a “sorrowing mother” enable us to examine the relationship between individual experiences and prescribed expressions of grief and mourning. While eighteenth-century conventions stressed quiet resignation to God’s will, emerging cultural changes increasingly enabled – indeed, encouraged – women to give public voice to their private emotions. By the nineteenth century, sentimental views of childhood, along with a culture of mourning, inspired parents – especially mothers – to give full expression to intense feelings of loss and sorrow. Lowry Wister’s narrative reveals how women responded to and negotiated various religious, cultural and literary conventions that shaped their understandings of motherhood and mourning. Her narrative illustrates the various ways in which individual women challenged cultural norms and helped usher in new forms of emotional and literary expression. Comparisons of Wister’s narrative to other eighteenth-century women’s writings on grief and mourning further illuminate the interplay between cultural convention and individual expression.

Associations between Prolonged Grief Disorder, Depression, Posttraumatic Stress Disorder, and Anxiety in Rwandan Genocide Survivors

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Schaal, Susanne; Dusingizemungu, Jean-Pierre; Jacob, Nadja; Neuner, Frank; Elbert, Thomas

2012-01-01

A number of studies have demonstrated that symptoms of prolonged grief disorder (PGD) represent a symptom cluster distinct from bereavement-related depression, anxiety, and posttraumatic stress disorder (PTSD). The aim of the present study was to confirm and extend these findings using the most recent criteria defining PGD. The authors interviewed…

Grief and mourning in schizophrenia.

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Wittmann, Daniela; Keshavan, Matcheri

2007-01-01

Depression and suicidality after first episode of psychosis are well-documented responses in patients with schizophrenia (Addington, Williams, Young, & Addington, 2004). The understanding of depression and suicidality has been increasingly refined through careful study. Researchers have identified a number of factors that may cause depression such as insight into the illness, feelings of loss and inferiority about the illness as a damaging life event, hopelessness about having a viable future with the illness and mourning for losses engendered by the illness. The authors argue that grief and mourning are not just an occasional reaction to the diagnosis of schizophrenia, but are a necessary part of coming to terms with having the illness. They offer three case examples, each of which illuminates a distinct way in which psychosis and mourning may be related--psychosis as a loss of former identity, psychosis as offering meaning and transformation, and psychosis as a way of coping with the inability to mourn. In their view, recovery depends on mourning illness-related losses, developing personal meaning for the illness, and moving forward with "usable insight" and new identity (Lewis, 2004) that reflects a new understanding of one's strengths and limitations with the illness.

How Adults With an Intellectual Disability Experience Bereavement and Grief: A Qualitative Exploration

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McRitchie, Robyn; McKenzie, Karen; Quayle, Ethel; Harlin, Margaret; Neumann, Katja

2014-01-01

This qualitative study explored the lived experiences of bereavement of 13 adults with an intellectual disability and found that their experiences could be situated within the concept of disenfranchised grief. The latter mediated participants' meaning making of the grieving process illustrated in the themes of intra- and interpersonal bereavement experiences, core beliefs about life and death, level of inclusion, and maintaining a continuing relationship with the deceased. The results suggest...

FEASIBILITY AND EFFECTIVENESS OF DYADIC PROLONGED EXPOSURE INTERVENTION FOR PREVENTING POSTTRAUMATIC GRIEF IN YOUNG CHILDREN: A CASE REPORT OF TWO SIBLINGS.

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Rachamim, Lilach

2017-09-01

This article highlights the feasibility of a dyadic prolonged exposure (DPE) intervention (L. Rachamim, I. Mirochnik, L. Helpman, N. Nacasch, & E. Yadin, ) in a 3-year-old preschooler and in a 6-year-old kindergartener immediately following the traumatic death of their younger sibling. It presents a detailed case description of the DPE treatment addressing traumatic grief and includes transcribed treatment dialogue. At the time of treatment termination, both children and caregivers resumed normal functioning. The results suggest that DPE intervention may ameliorate posttraumatic grief symptoms in young children. Controlled studies of preventive interventions for this population are clearly warranted. © 2017 Michigan Association for Infant Mental Health.

A Greek perspective on concepts of death and expression of grief, with implications for practice.

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Mystakidou, Kyriaki; Tsilika, Eleni; Parpa, Efi; Katsouda, Emmanuela; Vlahos, Lambros

2003-12-01

Death has been conceptualised in different ways by different cultures and civilizations. It is increasingly entering into the public consciousness and society is now more ready to discuss and lessen the fear of dying and grief than it has been in the past few decades. In Greece, by Classical times there was an increase in burial rituals and commemorative practices compared to earlier periods. When Christianity was introduced into Greece it attempted to change the way the dead were mourned, preaching immortality of the soul and resurrection of the dead. Nevertheless, the way people grieve and bury their dead in Greece has not changed greatly since before the introduction of Christianity, except for the difficulty experienced in witnessing burial procedures observed in the large cities. Burial and bereavement traditions were introduced to help Greeks cope with death and bereavement. In Greece today beliefs about grief and death are based both on the ancient and the Christian Orthodox traditions. Healthcare professionals need to develop cultural competence to improve nursing and future health care. If care is culturally informed and tailored its quality is improved.

Lifetime post-traumatic stress symptoms are related to the health-related quality of life and severity of pain/fatigue in patients with fibromyalgia.

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Dell'Osso, L; Carmassi, C; Consoli, G; Conversano, C; Ramacciotti, C E; Musetti, L; Massimetti, E; Pergentini, I; Corsi, M; Ciapparelli, A; Bazzichi, L

2011-01-01

The aim of the present study was to investigate the impact of lifetime potentially traumatic events, including losses, and of post-traumatic stress symptoms on the severity of illness and health-related quality of life in patients with fibromyalgia (FM). Seventy patients with FM, diagnosed according to the American College of Rheumatology criteria, were consecutively enrolled at the Unit of Rheumatology of the University of Pisa, Italy. Assessments included: SCID-I/P; the Fibromyalgia Impact Questionnaire (FIQ) and the Medical Outcomes Study Short Form-36 Health Survey (MOS SF-36), for the severity of pain; the Health-Related Quality of Life (HRQoL); the Trauma and Loss Spectrum Self-Report (TALS-SR) life-time version. The FIQ total score was related to the number of loss events (Domain I) and to symptoms of grief reactions (Domain II) and re-experiencing (Domain V) of the TALS-SR. The 'VAS fatigue' scores (FIQ) were significantly related to the TALS-SR symptoms of grief reactions (Domain II) and re-experiencing (Domain V). The Mental Component Summary and Bodily Pain scores of the MOS SF-36 were significantly related to all TALS-SR domains, the latter with the exception of the VIII (Arousal). Our results corroborate the presence of a relationship between the lifetime exposure to potentially traumatic events, in particular loss events, and lifetime post-traumatic stress symptoms and the severity of illness and HRQoL in patients with FM.

A Qualitative Study on the Grief of People Who Lose Their Only Child: From the Perspective of Familism Culture

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Yudi Zhang

2018-05-01

Full Text Available Shidu is the Chinese transliteration for ‘losing an only child,’ which indicates the death of the only child in the family. Shidu is a unique social phenomenon resulting from the One-Child Policy implemented in China for several decades. Shiduers are parents who have lost their only child. The grief research scholar Neimeyer (2012 argued that grief research should consider the role of different cultures in the grieving process. Familism culture is a collectivist culture that has a profound effect on Chinese society and is likely to produce a significant effect on the grieving process of shiduers; however, this effect has not yet received systematic attention in research. To explore the effect of familism culture on the grief of shiduers, we conducted semi-structured personal interviews in Beijing, China, with seven shiduers. The study results show that the effect of familism culture on the grief of shiduers includes three levels: cognition, emotion, and behavior. These levels are reflected in a variety of relationships, including relationships with ancestors, the deceased child, the spouse, relatives, Tong Ming Ren (the Chinese transliteration of ‘people who share the same fate’, and the country. The first four types of relationships are reflections of ‘direct familism culture,’ and the latter two types of relationships are reflections of ‘extended familism culture’. The relationships with the deceased child, relatives, and Tong Ming Ren are mainly supportive; the relationship with ancestors is mainly stressful; the relationship with the spouse has a dual nature; and the relationship with the country is contradictory. Over time, shiduers have abandoned the concept of familism culture and have moved toward reducing stress and increasing supportiveness. Psychological professionals, social workers, and government staff may refer to the results of this study to help shiduers obtain support and reduce stress from the described

Ameliorating treatment-refractory depression with intranasal ketamine: potential NMDA receptor actions in the pain circuitry representing mental anguish.

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Opler, Lewis A; Opler, Mark G A; Arnsten, Amy F T

2016-02-01

This article reviews the antidepressant actions of ketamine, an N-methyl-D-aspartame glutamate receptor (NMDAR) antagonist, and offers a potential neural mechanism for intranasal ketamine's ultra-rapid actions based on the key role of NMDAR in the nonhuman primate prefrontal cortex (PFC). Although intravenous ketamine infusions can lift mood within hours, the current review describes how intranasal ketamine administration can have ultra-rapid antidepressant effects, beginning within minutes (5-40 minutes) and lasting hours, but with repeated treatments needed for sustained antidepressant actions. Research in rodents suggests that increased synaptogenesis in PFC may contribute to the prolonged benefit of ketamine administration, beginning hours after administration. However, these data cannot explain the relief that occurs within minutes of intranasal ketamine delivery. We hypothesize that the ultra-rapid effects of intranasal administration in humans may be due to ketamine blocking the NMDAR circuits that generate the emotional representations of pain (eg, Brodmann Areas 24 and 25, insular cortex), cortical areas that can be overactive in depression and which sit above the nasal epithelium. In contrast, NMDAR blockade in the dorsolateral PFC following systemic administration of ketamine may contribute to cognitive deficits. This novel view may help to explain how intravenous ketamine can treat the symptoms of depression yet worsen the symptoms of schizophrenia.

Avoidance of Bereavement-Related Stimuli in Chinese Individuals Experiencing Prolonged Grief: Evidence from a Dot-Probe Task

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Meng Yu

2017-07-01

Full Text Available Background: Attentional bias refers to a preference for (e.g., vigilance or a shifting away (e.g., avoidance of one’s focus with respect to specific stimuli. Accumulating evidence suggests that an attentional bias toward death/threat-related stimuli exists in bereaved individuals experiencing prolonged grief (PG. Measuring for different processing may reflect different cognitive characteristics. Therefore, this study sought to compare information-processing biases in Chinese individuals with high versus low levels of PG symptomatology at supraliminal and subliminal levels, respectively.Method: A 2 (grief level × 2 (consciousness level × 2 (word type three-factor mixed design with supraliminal and subliminal tasks was utilized in the current study. Based on their Prolonged Grief Questionnaire-13 (PG-13 scores, 38 participants were included in the low-PG group, and 34 individuals were included in the high-PG group. All the participants completed a dot-probe task in which they were primed with death-related and life-related words paired with neutral stimuli.Results: High-PG individuals were slower in reacting to the death-related information in both supraliminal and subliminal tasks. After controlling for other symptoms in the backward deletion regression, PG-13 scores significantly predicted the avoidance tendency to death-related words in the supraliminal task, while anxiety was the best predictor of turning one’s vision away from death-related stimuli in the subliminal trials.Conclusion: The results suggested that high PG is associated with a tendency to avoid death-related words. Future research is needed to explore interventions that address the avoidance of death-related stimuli among individuals with elevated, or diagnosable, levels of PG.

Duelo, amor y subjetividad en adolescentes. Grief, love and subjectivity in teenagers.

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Gallo Acosta, Jairo; Muhete, Magnolia

2012-01-01

 Grief, love and subjectivity in teenagers.ResumenEl articulo presenta resultados de un proyecto hace parte de la línea de investigación Psicoanálisis y Campo social. Es una propuesta desde la teoría psicoanalítica, en donde se aborda el tema del duelo amoroso en adolescentes, tema relevante para identificar las representaciones de los adolescentes en este proceso, y donde la elaboración de un duelo puede ser un aspecto importante para sus vidas, por eso la importancia de analizar el duelo y ...

Grief Tourism on Destination Image Formation: Afyonkarahisar and Başkomutan National Historical Park

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Burhan KILIÇ

2011-06-01

Full Text Available The diversification of supply sources owned causes differences between destinations and special interest which is shaped for demand leads to become tourism widespread. In Turkey, there are many destinations where different features exist together. By means of alternative tourism types, various destinations and tourism types emerge. When all the events happened during the Independence War are considered in terms of national heritage, Afyonkarahisar is an important centre among grief tourism destinations. In research related to image components of Afyonkarahisar, confectionery, food products, and thermal tourism are the values of this destination that come to mind first. When the city is considered in terms of tourism, by highlighting the thermal tourism, the slogan “The Capital of Thermal Tourism” has been used. However it is hard to say that thermal tourism has a success taking the research into consideration. Therefore either other tourism values will be used to support the slogan available or with the work of a new image, a new image destination image will be created. The aim of this study is to eliminate the current negativity of Afyonkarahisar province’s destination image, strengthen the image and examine the availability of grief tourism which is one of the heritage tourism types so as to increase its market share

Velamento da angústia existencial do cidadão e do homem público e o sentido de um dever ser próprio a ações sérias Concealing the existential anguish of the citizen and of the public official and the meaning of a duty being inherent to serious actions

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Valderez F. Fraga

2009-02-01

Full Text Available Este artigo explora a complexidade do fenômeno da angústia fundamentalmente como angústia existencial da qual se ocupa especialmente Heidegger em íntima relação com o dasein, sem relegá-la ou excluir a literatura a respeito. A questão central é a presença fenomenal do homem comum e do homem público como ser-no-mundo, na vida e em suas organizações. A literatura escolhida orienta a discussão para fundamentos fenomenológicos como presença, impermanência, abertura, velamento, poder ser, fuga, bem como para disposições e posturas como querer ter, querer ser, assumir-se, recorrendo a um embasamento teórico para essa primeira discussão que questiona, inicialmente e durante o artigo, implicações da angústia heideggeriana nas expectativas de cidadania. A reflexão final emerge em forma de questão em tom paradoxal que por si só é manifestação de angústia e exemplo de necessidade da seriedade do homem diante do público, em toda a sua extensão, porque a angústia existencial não se manifestou simplesmente velada, mas como uma falta.Nowadays globally manifest uneasiness which affects common men as well as public citizens motivates this exploratory study towards complexity of anxiety as a phenomenon, not as an emotion, although without relegating it or excluding the related bibliography, but to fundamentally investigate existential anguish in accordance to Heidegger, that is, in connection with the dasein. The core question is the phenomenal presence of common and public men as a being-in-the-world of life and organizations. The selected literature drives that discussion to phenomenological basics such as presence, impermanence, openness, veiling, might-be, and escape, as well as dispositions and postures like willing-to-have, willing-to-be, and assuming-oneself, resorting to a theoretical basis for this primary discussion which questions the Heideggerian anxiety implications on citizenship expectancies. The final reflection

AMELIORATING TREATMENT-REFRACTORY DEPRESSION WITH INTRANASAL KETAMINE: POTENTIAL NMDA RECEPTOR ACTIONS IN THE PAIN CIRCUITRY REPRESENTING MENTAL ANGUISH

Science.gov (United States)

Opler, Lewis A.; Opler, Mark G.; Arnsten, Amy F.T.

2014-01-01

This paper reviews the anti-depressant actions of the N-methyl-D-aspartame glutamate receptor (NMDAR) antagonist, ketamine, and offers a potential neural mechanism for intranasal ketamine’s ultra-rapid actions based on the key role of NMDAR in the nonhuman primate prefrontal cortex (PFC). Although intravenous ketamine infusions can lift mood within hours, the current review describes how intranasal ketamine administration can have ultra-rapid antidepressant effects, beginning within minutes (5–40 minutes) and lasting hours, but with repeated treatments needed for sustained antidepressant actions. Research in rodents suggests that increased synaptogenesis in PFC may contribute to the prolonged benefit of ketamine administration, beginning hours after administration. However, these data cannot explain the relief that occurs within minutes of intranasal ketamine delivery. We hypothesize that the ultra-rapid effects of intranasal administration in humans may be due to ketamine blocking the NMDAR circuits that generate the emotional representations of pain (e.g. Brodmann Areas 24 and 25, insular cortex), cortical areas that can be overactive in depression and which sit above the nasal epithelium. In contrast, NMDAR blockade in the dorsolateral PFC following systemic administration of ketamine may contribute to cognitive deficits. This novel view may help to explain how intravenous ketamine can treat the symptoms of depression yet worsen the symptoms of schizophrenia. PMID:25619798

Use of Facebook in the maternal grief process: An exploratory qualitative study.

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Perluxo, Diana; Francisco, Rita

2018-02-01

This study seeks to explore the potential implications of Facebook use in the process of maternal grief. The participants were 11 women who had lost their children due to accidents or prolonged illness. Semistructured interviews were conducted and subjected to thematic analysis. The participants stated that they used Facebook to receive support, to identify with other mothers, to remember the child who died, to access the child's information, to honor him/her, and to express their feelings. The use of Facebook can play a very important role in the initial phase of grieving due to the functions of this social network.

Clinical correlates of complicated grief among individuals with acute coronary syndromes

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Pini S

2015-10-01

Full Text Available Stefano Pini,1 Camilla Gesi,1 Marianna Abelli,1 Alessandra Cardini,1 Lisa Lari,1 Francesca Felice,2 Rossella Di Stefano,2 Gianfranco Mazzotta,3 Francesco Bovenzi,4 Daniele Bertoli,5 Lucia Borelli,4 Paola Michi,1 Claudia Oligeri,3 Alberto Balbarini,2 Vijaya Manicavasagar6 1Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, 2Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, 3Unit of Cardiology, Ospedale Sant’Andrea, La Spezia, 4Cardio-Respiratory Department, Ospedale Campo di Marte, Lucca, 5Unit of Cardiology, Ospedale San Bartolomeo, Sarzana (SP, Italy; 6Black Dog Institute, University of New South Wales, Sydney, NSW, Australia Objective: The study aimed at exploring bereavement and complicated grief (CG symptoms among subjects without a history of coronary heart disease (CHD at the time of a first acute coronary syndrome (ACS and to evaluate the relationship of CG symptoms and ACS. Method: Overall, 149 subjects with ACS (namely, acute myocardial infarct with or without ST-segment elevation or unstable angina, with no previous history of CHD, admitted to three cardiac intensive care units were included and evaluated by the Structured Clinical Interview for Complicated Grief (SCI-CG, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and the 36-item Short-Form Health Survey (MOS-SF-36. Results: Of the total sample of 149 subjects with ACS, 118 (79.2% met criteria for DSM-5 persistent complex bereavement disorder. Among these, subjects who lost a partner, child, or sibling were older (P=0.008, less likely to be working (P=0.032, and more likely to be suffering from hypertension (P=0.021, returned higher scores on the SCI-CG (P=0.001 and developed the index ACS more frequently between 12 and 48 months after the death than those who lost a parent or another relative (P≤0.0001. The occurrence of ACS 12–48 months (P=0.019 after the loss was

Assessing the Role of Attachment to God, Meaning, and Religious Coping as Mediators in the Grief Experience

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Kelley, Melissa M.; Chan, Keith T.

2012-01-01

Research has examined the relationship of styles of attachment to others and meaning with grief and the stress-related growth process. Less has been written on styles of attachment to God and patterns of religious coping and how these constructs may impact adjustment in persons dealing with loss. This study examines the roles of attachment to God,…

ADAPTAÇÃO TRANSCULTURAL E EVIDÊNCIAS DE VALIDAÇÃO DA PERINATAL GRIEF SCALE

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Gisele Ferreira Paris

2017-01-01

Full Text Available Objetivo : realizar la adaptación transcultural y validación de pruebas de la Perinatal Grief Scale para el portugués Brasil y Canadá francés. Metodo : estudio metodológico, con aplicación de Escala de Duelo Perinatal desde el conjunto de procedimientos de adaptación transcultural. La populación fue compuesta por todas las mujeres que tuvieron óbito fetal en el año de 2013 vecinas en el municipio de Maringá-Brasil y participantes del Centre d’Études et de Recherche en Intervention Familiale en la Université du Québec en Outaouais - Canadá. Resultados : la escala en las versiones en portugués y francés demostró para ser confiable en las dos poblaciones. Coeficiente alfa de Cronbach de la escala aplicada en Brasil fue de 0,93 y aplicada en Canadá fue 0.94. Versión portuguesa, cuatro elementos no correlacionan con la escala total. Conclusión : la Perinatal Grief Scale puede utilizarse para identificar el estado de duelo en mujeres que tenían la muerte fetal, en su versión de cada país.

Alignment of the Kübler-Ross grief cycle phases with the process of adaptation to type 1 diabetes mellitus.

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Isla Pera, Pilar; Moncho Vasallo, Joaquín; Guasch Andreu, Oscar; Torras Rabasa, Alberto

2008-02-01

To understand the process of adaptation to type 1 diabetes mellitus (DM1) and analyze its alignment with the grief cycle phases described by Kübler-Ross. We performed an ethnographic study through in-depth interviews with 20 patients, 10 relatives and 12 health professionals (6 physicians and 6 nurses). For the analysis, the Miles and Huberman qualitative data analysis model was used. Patients diagnosed with DM1 and their families face a loss of lifestyle and of the objects, real or imaginary, of their previous life. Patients and relatives experience emotional reactions that in some cases can be similar to the grief cycle phases described by Kübler-Ross for terminal diseases (denial, anger, bargaining, depression and acceptance). However, there are some differences depending on personal and psycho-social factors. Health professionals tend to relate low adherence to denial of the disease, but some patients feel threatened by the demands of treatment and control and their effects on their quality of life, and consciously choose not to follow recommendations. It is more realistic to talk about disease adaptation than acceptance, since the loss processes are ongoing and patients must reconstruct their identity according to their situation. The grief cycle also affects the family and may differ from that of the patient in its duration, intensity and assessment of problems. Adaptation is a complex process in which many variables intervene. There are observable differences among the mechanisms used by each specific individual. Healthcare professionals, and specifically nurses, should consider the multiple psycho-social dimensions of chronic disease. Copyright © 2008 Sociedad Española de Endocrinología y Nutrición. Published by Elsevier Espana. All rights reserved.

Dreams of the Dead among Cambodian Refugees: Frequency, Phenomenology, and Relationship to Complicated Grief and Posttraumatic Stress Disorder

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Hinton, Devon E.; Field, Nigel P.; Nickerson, Angela; Bryant, Richard A.; Simon, Naomi

2013-01-01

The authors investigated the importance of dreams of the deceased in the experiencing of prolonged grief (PG) and posttraumatic stress disorder (PTSD) among Cambodian refugees who survived the Pol Pot genocide (1975-1979). Such dreams were frequent in the last month (52% of those surveyed), and most often involved a relative who died in the Pol…

Mourning and Grief on Facebook: An Examination of Motivations for Interacting With the Deceased.

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Willis, Erin; Ferrucci, Patrick

2017-12-01

Facebook not only changed the way we communicate but also the way we mourn and express grief. The social networking site allows users to interact with deceased users' walls after death. This study utilized textual analysis to categorize Facebook posts ( N = 122) on 30 deceased users' walls according to uses and gratifications theory. Most posts were found to be motivated by entertainment, followed by integration and social interaction. Facebook users posted memories, condolences, and interacted with friends and family members in the deceased user's network. Implications and potential future research are discussed.

Helping nurses cope with grief and compassion fatigue: an educational intervention.

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Houck, Dereen

2014-08-01

Oncology nurses may experience intense physical and emotional exhaustion, identified in the literature as symptoms of cumulative grief and compassion fatigue, with significant consequences for both nurses and organizations. The first step in preventing these consequences is recognition. Organizations should provide nurses with resources including education, counseling, and opportunities to grieve. Nurses need to learn the importance of work-life balance, self-care strategies, and communication skills. Using recommendations from the literature, an educational intervention was designed with the purpose of providing nurses with knowledge, skills, and resources to practice effective self-care and recognize when assistance is needed. The program's objective was to help nurses develop the coping skills and inner resources necessary to maintain their emotional and physical health.

Emotional intertexts: female romantic friendship and the anguish of marriage

OpenAIRE

Furneaux, Holly

2009-01-01

Romantic friendship between women has been a fertile ground for explorations of Victorian sensory culture, inciting nuanced attention to the emotional and erotic components of intimacy. Work in this area has advanced our understanding of the histories of gender, sexuality and the family and of the history of emotions. This essay takes a new approach to contests over the (in)compatibility of female friendship and marriage, exploring the rich vocabularies through which women’s pain at an intima...

FCJ-160 Politics is Serious Business: Jacques Rancière, Griefing, and the Re-Partitioning of the (NonSensical

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Steve Holmes

2013-12-01

Full Text Available This article contextualises certain elements of ‘griefing’ as a form of political action in virtual world by drawing on the political philosophy of Jacques Rancière. A small but growing number of scholars are starting to view griefing as an avant-garde, anarchist, or hacktivist political activity. I suggest that Rancière offers a more specific articulation of what constitutes political action and activism for griefing collectives because his understanding of politics is entirely grounded in relationship to the types of communities and individual political equality. The article focuses specifically on the Patriotic Nigras activities in the Great Habbo Raid of 2006 in an attempt to understand how a Rancièreian framework can provide some analytical tools for articulating politics in virtual worlds. I conclude that the PN do not ultimately realise a Rancièreian framework. They challenge not partitions of the sensible, but partitions of the nonsensical specific to the different operation of politics and community formation in virtual worlds.

Coping with losses, grief, and mourning in prostate cancer.

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Wittmann, Daniela

2015-01-01

Prostate cancer is a highly prevalent disease with a high likelihood of survival. If treated, survivors live with significant and lasting treatment-related side effects. Surgical treatment is associated with urinary incontinence and erectile dysfunction, and radiation leads to urinary and bowel irritability as well as erectile dysfunction. Patients who undergo hormonal treatment cope with sexual dysfunction, bone density loss, hot flashes, mood symptoms, and cardiac and metabolic disorders. Functional losses have a significant impact on patients and their partners' quality of life and are associated with distress and psychosocial morbidity. Psychosocial treatment is largely unavailable in usual care, but has been shown to reduce distress, to increase positive reappraisal of the illness, and to contribute to the recovery of sexual intimacy. Treatment for grief and mourning, typical reactions to loss, has not been introduced into psychosocial interventions but is increasingly recognized as a path toward a 'new normal' after prostate cancer treatment. © 2015 S. Karger AG, Basel.

"Dulling the Edges": Young Men's Use of Alcohol to Deal With Grief Following the Death of a Male Friend

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Creighton, Genevieve; Oliffe, John; Matthews, Jennifer; Saewyc, Elizabeth

2016-01-01

Background: The death of a male friend can be challenging for men because expressions of grief can be governed and restrained by dominant ideals of masculinity. It is common for young men to engage in health risk practices, such as alcohol overuse, to deal with feelings of sadness. Objective: This qualitative study investigated the ways that young…

Teaching in Grief: Critical Reflections, Redefining Justice, and a Reorientation to Teaching

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Heather Cherie Moore

2016-11-01

Full Text Available Since the creation of the #BlackLivesMatter movement, many scholars from historically underrepresented communities have revisited discourse on social movements. Many supporters of the #BlackLivesMatter movement are outsiders participating in solidarity with organizers across the globe.  But what happens when questions of police brutality and injustice adversely impact your family and your career? Using the self-narrative method and grief framework, the author describes her teaching transformation in a pilot Multicultural Education course immediately following the death of her cousin in police custody. The author describes how the terms injustice, action, and pedagogy changed over time and took on new meanings during an extended grieving period.

Evolutionizing Grief: Viewing Photographs of the Deceased Predicts the Misattribution of Ambiguous Stimuli by the Bereaved

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Claire White

2013-07-01

Full Text Available We propose a cognitive-evolutionary model of grief where the function of grief is to reunite a person with an absent partner where this is possible, and where it is not, to disengage and reorientate the individual from the lost agent. The present study investigates the potential factors that affect reunion-promoting symptoms by focusing on the misattribution of external stimuli to the deceased by the bereaved - which we term ‘false recognitions’. We propose three factors that relate to false recognitions: First, we propose that strong attachment to the deceased predisposes one to false recognitions; second, we predict that viewing photographs of the deceased (that were taken when the individual was alive perpetuates false recognitions; and third, we propose that time elapsing since the death diminishes the frequency of false recognitions. In a survey of 164 recently bereaved (<25 months pet owners in the U.S. and U.K., predictions concerning the association of the predictor and outcome variables were confirmed. The strongest predictor was the frequency of viewing photographic images of the deceased, a pattern consonant with our premise that, being evolutionarily novel, realistic photographs are treated as reliable cues that the agent remains a viable relationship partner. This research demonstrates the potential of evolutionary theory to inform mainstream bereavement research.

OA57 The digitalisation of dying, loss and grief on social media channels.

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Taubert, Mark; Norris, James

2015-04-01

The internet and birth of social media channels have changed the way in which we deal with death, loss and grief forever. Our photo albums are now saved digitally and shared on Facebook. Our private thoughts are now relayed on Twitter. Each year we spend more of our lives online, this workshop will address what happens as we approach death and when we switch off. After building a relationship digitally they recently presented together at the Macmillan Primary Care Conference on the subject 'Can we Palliate Social media'. The outcome of the workshop can be viewed below: 'Can we Palliate Social Media' workshop (about) - http://deadsocial.org/blog/222-macmillan-primary-care-conference BMJ review/results of workshop - http://blogs.bmj.com/spcare/2014/12/04/palliating-social-media-a-seminar-workshop-at-the-macmillan-professionals-conference-in-london/ We will highlight how the digital landscape has changed to help evoke thought and discussion around the subject of digitising death. They will explore the ethical and moral questions regarding end of life within the digital context. The role of the HCP will be examined in relation to social media and patient practice. All attendees will be provided with a number of simple tasks to carryout online. This will again provide a better understanding around the conversations that are occurring online and the digitisation of death. An interactive 40 min workshop will be directed by us. This will conclude with a 20-minute discussion. Leaflets containing relevant tasks for HCPs to carryout online can be carried out after the workshop. Understanding of the main social and digital channels that we (in the UK) use today. Understanding of how online channels have changed how we communicate and behave. The different ways grieving, remembering and mourning occurs online How death, grief and loss is different online Examination of how social media is breaking down the notion of death Reflect on how could/should HCPs and EOL professionals

Del dolor al duelo: límites al anhelo frente a la desaparición forzada. // From the bereavement to the grief: limits to the yearning faced with the frorced dissapearance.

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Victoria Eugenia Diaz.

2008-12-01

Full Text Available This article develops the research question about the logic of the grief process when a subject lost is caused by forced disappearance of a loved one. Even though the study of the sources allows to state that the common response to this event is a suspended bereavement, research results allow to propose that there are collective -justice and ritual and individual –grief act- mechanisms which can contribute for a subject to overcome the obstacles and to begin grief resolution. In order to come to this conclusion, the concepts of grief work, reality test, bereavement, and act are discussed to be able to state that the grief for the disappearance does not depend on the reunion with the lost object, nor on the find of a corpse, but on a change of the subject/object relationship where this latter is psychically assumed as radically lost. // El artículo desarrolla la pregunta de investigación en torno a la lógica del proceso de duelo cuando la pérdida de un sujeto es causada por la desaparición forzada de un ser amado. Si bien el estudio de las fuentes permite afirmar que la respuesta común a este evento es la de un dolor suspendido, los resultados de la investigación permiten proponer que existen mecanismo colectivos —la justicia y el ritual— y particulares —el acto de duelo— que pueden contribuir a que un sujeto movilice los obstáculos e inicie la elaboración de su duelo. Se discuten, para llegar a esta conclusión, las nociones de trabajo de duelo, de prueba de realidad, de dolor y de acto, para llegar a afirmar que el duelo por la desaparición no depende del reencuentro con el objeto perdido, ni siquiera bajo la forma de hallazgo del cadáver, sino de un cambio en la relación del sujeto con el objeto donde se instaure psíquicamente este último como radicalmente perdido.

Keeping the Music Alive: Using the "Grief and Hope Box" with Adult Offenders with Co-Occurring Mental Health and Substance Use Issues

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Gee, Robert; Springer, Paul; Bitar, George; Drew, Faith; Graff, Chad

2005-01-01

Individuals with co-occurring mental health and substance use disorder (COD) present unique challenges for counselors. When individuals are incarcerated, they suffer unique forms of losses, including the loss and grief of their family members. In addition, they often struggle with stigma and cultural stereotypes that are oppressive and…

ICU versus Non-ICU Hospital Death: Family Member Complicated Grief, Posttraumatic Stress, and Depressive Symptoms.

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Probst, Danielle R; Gustin, Jillian L; Goodman, Lauren F; Lorenz, Amanda; Wells-Di Gregorio, Sharla M

2016-04-01

Family members of patients who die in an ICU are at increased risk of psychological sequelae compared to those who experience a death in hospice. This study explored differences in rates and levels of complicated grief (CG), posttraumatic stress disorder (PTSD), and depression between family members of patients who died in an ICU versus a non-ICU hospital setting. Differences in family members' most distressing experiences at the patient's end of life were also explored. The study was an observational cohort. Subjects were next of kin of 121 patients who died at a large, Midwestern academic hospital; 77 died in the ICU. Family members completed measures of CG, PTSD, depression, and end-of-life experiences. Participants were primarily Caucasian (93%, N = 111), female (81%, N = 98), spouses (60%, N = 73) of the decedent, and were an average of nine months post-bereavement. Forty percent of family members met the Inventory of Complicated Grief CG cut-off, 31% met the Impact of Events Scale-Revised PTSD cut-off, and 51% met the Center for Epidemiologic Studies Depression Scale depression cut-off. There were no significant differences in rates or levels of CG, PTSD, or depressive symptoms reported by family members between hospital settings. Several distressing experiences were ranked highly by both groups, but each setting presented unique distressing experiences for family members. Psychological distress of family members did not differ by hospital setting, but the most distressing experiences encountered at end of life in each setting highlight potentially unique interventions to reduce distress post-bereavement for family members.

A biopsychosocial approach to sexual recovery after prostate cancer surgery: the role of grief and mourning.

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Wittmann, Daniela; Foley, Sallie; Balon, Richard

2011-01-01

Erectile dysfunction is a common side-effect of prostate cancer surgery that causes men suffering and hinders their sexual recovery. There are studies that describe men's and partners' distress and couples' difficulties engaging in sexual recovery. A few studies show a short-term benefit of brief psycho-social interventions such as psychoeducation and counseling. However, there is no conceptual framework to guide psychosocial treatments. We propose a model of intervention in sexual recovery that incorporates grief and mourning as a gateway to new and satisfying sexuality after prostate cancer treatment.

[The influence of unreconciled grief in the family on the functioning and development of a child].

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Janusz, Bernadetta; Drozdzowicz, Lucyna

2013-01-01

The aim of the work is to present the influence of unreconciled grief in a family for functioning and growth of a child. The paper is based on some examples of clinical work from the field of family therapy, where developmental problems of children followed their carer's inability to cope with death and bereavement. Presented cases from family therapy serve as examples of possible therapeutic interventions in such situations. They show examples of developmental disturbances and psychopathology of the child who stays in relationship with deeply bereaved intimates.

THE ADOLESCENT FEELINGS RELATED TO THE BULLYING PHENOMENA: POSSIBILITIES TO THE NURSING ASSISTANCE IN THIS CONTEXT

OpenAIRE

Agnes Schutz de Oliveira; Priscila da Silva Antonio

2006-01-01

ABSTRACT: Bullying is a devastating phenomenon that can affect the adolescent’s self-esteem and mental health. Generally occurs in school environment when the adolescent is more susceptible or vulnerable to verbal or moral aggressions that cause to them anguish and pain, meaning as a status of social exclusion. Most of time, health problems as anorexia, bulimia, depression, anxiety and also the suicide, appears. By the way, nurses are able to prevent injuries to various problems, and also con...

Meaningful Communication Before Death, but Not Present at the Time of Death Itself, Is Associated With Better Outcomes on Measures of Depression and Complicated Grief Among Bereaved Family Members of Cancer Patients.

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Otani, Hiroyuki; Yoshida, Saran; Morita, Tatsuya; Aoyama, Maho; Kizawa, Yoshiyuki; Shima, Yasuo; Tsuneto, Satoru; Miyashita, Mitsunori

2017-09-01

Few studies have explored the clinical significance of the family's presence or absence at the moment of a patient's death and meaningful communication (saying "goodbye") in terms of post-bereavement outcomes. To explore the potential association between the family's depression/complicated grief and their presence at the moment of a patient's death and the patient's communication with the family. A nationwide questionnaire survey was conducted on 965 family members of cancer patients who had died at palliative care units. More than 90% of family members wished to have been present at the moment of death (agree: 40%, n = 217; strongly agree: 51%, n = 280); 79% (n = 393) thereof were present. Families' presence at death was not significantly associated with the occurrence of depression and complicated grief, but the dying patient's ability to say "goodbye" to the family beforehand was (depression: adjusted odds rate, 0.42; 95% CI, 0.26-0.69 adjusted P = 0.001; complicated grief: adjusted odds rate, 0.53; 95% CI, 0.29-0.94 adjusted P = 0.009). Many families wished to be present at the moment of the patient's death; however, meaningful communication (saying "goodbye") between the patient and family members, and not their presence or absence itself, was associated with better outcomes on measures of depression or complicated grief. Health care professionals could consider promoting both mutual communication (relating to preparation for death) between family members and patients before imminent death, as well as the family's presence at the moment of death. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Hypnosis in Cancer Care.

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Wortzel, Joshua; Spiegel, David

2017-07-01

Cancer affects a growing proportion of the population as survival improves. The illness and its treatment brings a substantial burden of symptoms, including pain, anxiety, insomnia, and grief. Here, the uses of hypnosis in the treatment of these cancer-related problems will be reviewed. The utility of measuring hypnotizability in the clinical setting will be discussed. The current neurobiology of hypnotizability and hypnosis will be reviewed. Methods and results of using hypnosis for pain control in acute and chronic settings will be presented. Effects of hypnotic analgesia in specific brain regions associated with pain reduction, notably the dorsal anterior cingulate cortex and the somatosensory cortex, underlies its utility as a potent and side-effect free analgesic. Methods for helping those with cancer to better manage their anxiety, insomnia, and grief will be described. These involve facing disease-related stressors while dissociating the experience from somatic arousal. Given the serious complications of medications widely used to treat pain, anxiety, and insomnia, this article provides methods and an evidence base for wider use of techniques involving hypnosis in cancer care. Altering patients' perception of pain, disease-related stress, and anxiety can help change the reality of their life with cancer.

31 CFR 323.2 - Rules governing availability of information.

Science.gov (United States)

2010-07-01

.... Privacy interests, in the sense of the right to control, use, or disclose information about oneself, cease... survive death where disclosure would cause embarrassment, pain, grief, or disrupt the peace of mind, of...

Death on the digital landscape: a preliminary investigation into the grief process and motivations behind participation in the online memoriam.

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Egnoto, Michael J; Sirianni, Joseph M; Ortega, Christopher R; Stefanone, Michael

2014-01-01

Increasingly, individuals are bonding and maintaining relationships online. These digital representations of ourselves allow us to connect with others in ways previously not possible. One behavior that is growing in online presentations of self is grieving after the death of an individual in our social network. This work investigates the outcomes of online grieving from a transcorporeal communication model perspective, and draws conclusions on the outcomes of online grief behaviors.

A trial essay about studies of Grief Toward to recovery support for mothers who abuse their children

OpenAIRE

遠藤, 野ゆり

2016-01-01

This paper is a short essay about studies of Grief which are written by Sigmund Freud, Melanie Klein, John Bowlby, and Keigo Okonogi. The final aim is to describe parents’, mainly mother’s mechanism of recovery process from their abusing of children. This paper is one piece of this aim. The lag of support for abusing mother seems to be caused by the complexity and difficulty of their mechanism. They often have been abused in their childhood and can’t remember it. The process of recovery is pa...

Loss and grief process and Occupational Therapy assistance in scalping situations

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Andreza Mourão Lopes

2013-08-01

Full Text Available In this research, we aimed to understand the loss and grief process and the occupational therapy assistance to a hospitalized child undergoing a scalping situation. It is a case study of qualitative approach. This survey was carried out with the participation of an 8-year-old female scalping victim. Results revealed that the scalping caused many changes such as loss of hair and parts of the facial skin. The child was hospitalized, staying away from occupational activities such as studying, playing, among others. We observed the expression of feelings such as fear, shame, anxiety and sadness generated by hair loss. Thus, we believe that this research is of high relevance because it allowed contact with a theme so characteristic of northern Brazil, as well as with the perception and clarification about the importance of occupational therapy assistance in providing space for expression and reframing of the doings, giving the opportunity to this child to resume her significant occupational activities.

Symptoms of post-traumatic stress disorder, severe psychological distress, explosive anger and grief amongst partners of survivors of high levels of trauma in post-conflict Timor-Leste.

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Silove, D M; Tay, A K; Steel, Z; Tam, N; Soares, Z; Soares, C; Dos Reis, N; Alves, A; Rees, S

2017-01-01

Little is known about the mental health of partners of survivors of high levels of trauma in post-conflict countries. We studied 677 spouse dyads (n = 1354) drawn from a community survey (response 82.4%) in post-conflict Timor-Leste. We used culturally adapted measures of post-traumatic stress disorder (PTSD), psychological distress, explosive anger and grief. Latent class analysis identified three classes of couples: class 1, comprising women with higher trauma events (TEs), men with intermediate TEs (19%); class 2, including men with higher TEs, women with lower TEs (23%); and class 3, comprising couples in which men and women had lower TE exposure (58%) (the reference group). Men and women partners of survivors of higher TE exposure (classes 1 and 2) had increased symptoms of explosive anger and grief compared with the reference class (class 3). Women partners of survivors of higher TE exposure (class 2) had a 20-fold increased rate of PTSD symptoms compared with the reference class, a pattern that was not evident for men living with women exposed to higher levels of trauma (class 1). Men and women living with survivors of higher levels of trauma showed an increase in symptoms of grief and explosive anger. The manifold higher rate of PTSD symptoms amongst women living with men exposed to high levels of trauma requires replication. It is important to assess the mental health of partners when treating survivors of high levels of trauma in post-conflict settings.

Grief and Bereavement Issues and the Loss of a Companion Animal: People Living with a Companion Animal, Owners of Livestock, and Animal Support Workers

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Chur-Hansen, Anna

2010-01-01

Companion animals play various roles in people's lives and these roles can impact on loss, grief, bereavement and mourning when the animal has been lost, whether that is through death, when missing, or when relinquished. This paper considers not only companion animal owners, but also those who own farm animals and those who work in animal service…

Shaping the pain: Ancient Greek lament and its therapeutic aspect?

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Šijaković Đurđina

2011-01-01

despair leads to anger and vengefulness, is found written or filmed: it is captured in work of art, but it emits folklore and ritual characteristics. Her sorrowful dirge, hers and of so many other women, is deeply rooted in funeral rites, and so, although a spontaneous expression of grief, it obeys certain ritual rules. One of the most important aspects of the lament is its therapeutic aspect: by verbalizing, expressing, externalizing pain and by sharing it with others, the pain itself becomes more bearable both for woman that laments and for other bereaved. From that perspective I am re-reading one of the most beautiful Serbian epic poems, The Death of Jugović's Mother, which tells us about a mother that didn’t lament.

[Compassionate care for terminally ill term and preterm infants].

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Schulze, A; Wermuth, I

2007-04-01

Involvement of the family in decisions to withhold or withdraw intensive care and parental involvement in care planning for terminally ill infants does not aggravate or prolong parents' grief responses, their feelings of guilt, or the incidence of pathological grief responses. Effective physical pain and symptom management is critically important. Compassionate care plans, however, need to implement a number of other and equally important components. Parents are not uniform in their perceived needs to make various kinds of contacts with their dying infant. They should be allowed to make their individual choices regarding contact with their baby during that time. The perinatal loss of a twin infant appears to evoke no less serious stress and risks to parents' compared to the loss of a singleton. The disruption of family life during a perinatal loss affects siblings of the baby, and their specific needs should be acknowledged. Post-death or post-autopsy meetings with the family should routinely be scheduled a few weeks after death, and bereavement support should actively be offered. Parents need to be informed about differences to be expected between maternal and paternal grief responses. The risk of pathological grief variants and chronic grief should be mentioned to parents because professional help is required in such occurrence.

Efficient conditioned pain modulation despite pain persistence in painful diabetic neuropathy.

Science.gov (United States)

Granovsky, Yelena; Nahman-Averbuch, Hadas; Khamaisi, Mogher; Granot, Michal

2017-05-01

Alleviation of pain, by either medical or surgical therapy, is accompanied by transition from less efficient, or pro-nociceptive, to efficient conditioned pain modulation (CPM). Spontaneous decrease or resolution of pain with disease progression is reported for some patients with painful diabetic neuropathy (PDN). To explore whether CPM changes similarly in parallel to spontaneous resolution of pain in PDN patients. In this cross-sectional study, thirty-three patients with PDN underwent psychophysical assessment of pain modulation on the forearm, remote from the clinical pain. Pain duration was not correlated with neuropathic pain intensity, yet, it correlated with CPM efficiency; patients with longer pain duration had same pain level, but more efficient CPM than those with short-pain duration (ρ = -0.417; P = 0.025, Spearman correlation). Patients with pain more than 2 years (median split) expressed efficient CPM that was not different from that of healthy controls. These patients also had lower temporal summation of pain than the short-pain duration patients group ( P < 0.05). The 2 patient groups did not differ in clinical pain characteristics or use of analgesics. Pro-nociception, expressed by less efficient CPM and high temporal summation that usually accompanies clinical painful conditions, seems to "normalize" with chronicity of the pain syndrome. This is despite continuing pain, suggesting that pro-nociceptivity in pain syndromes is multifactorial. Because the pain modulation profile affects success of therapy, this suggests that different drugs might express different efficacy pending on duration of the pain in patients with PDN.

Sports Medicine and Rehabilitation Team Clinic: Comparative Model Analysis of Navy and Marine Corps Options

Science.gov (United States)

2003-05-01

Epididimitis 820408 F 3 Bilatet PFS/Poss Right SFX 820913 F 1 Grief, Self Harm Threat 820203 M I Bilate Plantar Fascitis 810415 F 1 PFS 771105 M 2 ACL Tear...820315 M 2 Right Radius/Unlar Fracture 800319 M 1 Allergies 800408 M 3 Right Knee Pain 800722 M 1 Right Plantar Fascitis 810506 M 1 Dental, Abscess 810720...M 7 Bilateral Plantar Fasciitis 820226 M 2 Left IT Band Syndrome 811227 F 6 Left Foot Pain 730512 M 5 Bilateral Foot Pain/Stress Fracture SMART

Ecrire et souffrir : L’inspiration partagée de Constance Fenimore Woolson et de Henry James Literature and Grief: Constance Fenimore Woolson and Henry James, A Common Inspiration

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Jeannine Hayat

2007-01-01

Full Text Available Miss Grief is a story by Constance Fenimore Woolson, an American novelist who often wrote about the difficulty a woman had in becoming an artist — a writer or a painter — in the nineteenth century. This tale is a very strange text, a kind of anticipation of a meeting to come, in Italy, in 1880, between Woolson and Henry James, and a friendship which lasted until the former’s death in 1894. For thirteen years, both writers would share a common inspiration. Death itself could not break the links between the two authors, who were connected even when settled in different European countries. William James, who was a member of the American Society for Psychical Research, probably helped his brother Henry to communicate — or so it appears — in some way with Woolson, even after her fatal accident, or possible suicide, in Venice. Henry James probably had in mind Miss Grief, a story by his dead friend, before writing some of his books. Indeed, Woolson had been the first to develop the image of “the figure in the carpet,” which was later transformed by Henry James. Woolson was also the first to devise a plot which Henry James would later use as a canvas for his novel The Wings of the Dove. What is an author and what is authorship? It seems impossible to separate what is Woolson’s and what is Henry James’s in four works of fiction that are in fact to be read together : Miss Grief, The Figure in the Carpet, The Beast in the Jungle, The Wings of the Dove.

Facilitated pronociceptive pain mechanisms in radiating back pain compared with localized back pain

DEFF Research Database (Denmark)

Vaegter, Henrik Bjarke; Palsson, Thorvaldur Skuli; Graven-Nielsen, Thomas

2017-01-01

Facilitated pain mechanisms and impaired pain inhibition are often found in chronic pain patients. This study compared clinical pain profiles, pain sensitivity, as well as pro-nociceptive and anti-nociceptive mechanisms in patients with localized low back pain (n=18), localized neck pain (n=17......), low back and radiating leg pain (n=18), or neck and radiating arm pain (n=17). It was hypothesized that patients with radiating pain had facilitated pain mechanisms and impaired pain inhibition compared with localized pain patients. Cuff algometry was performed on the non-painful lower leg to assess...... threshold (HPT) at the non-painful hand were also assessed. Clinical pain intensity, psychological distress, and disability were assessed with questionnaires. TSP was increased in patients with radiating back pain compared with localized back pain (Ppain or localized low...

Parents' Faith and Hope during the Pediatric Palliative Phase and the Association with Long-Term Parental Adjustment.

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van der Geest, Ivana M M; van den Heuvel-Eibrink, Marry M; Falkenburg, Nette; Michiels, Erna M C; van Vliet, Liesbeth; Pieters, Rob; Darlington, Anne-Sophie E

2015-05-01

The loss of a child is associated with an increased risk for developing psychological problems. However, studies investigating the impact of parents' faith and hope for a cure during the palliative phase on long-term parental psychological functioning are limited. The study's objective was to explore the role of faith and hope as a source of coping and indicator of long-term parental adjustment. Eighty-nine parents of 57 children who died of cancer completed questionnaires retrospectively, exploring faith, hope, and sources of coping, and measuring parents' current level of grief and depression. For 19 parents (21%) faith was very important during the palliative phase. The majority of parents remained hopeful for a meaningful time with their child (n=68, 76%); a pain-free death (n=58, 65%); and a cure (n=30, 34%). Their child (n=70, 79%) was parents' main source of coping. Twelve parents (14%) suffered from traumatic grief, and 22 parents (25%) showed symptoms of depression. Parents' faith was not associated with less long-term traumatic grief (OR=0.86, p=0.51) or symptoms of depression (OR=0.95, p=0.74), and parents' hope for a cure was not related to more long-term traumatic grief (OR=1.07, p=0.71) or symptoms of depression (OR=1.12, p=0.47). Faith was important for a minority of parents and was not associated with less long-term traumatic grief or symptoms of depression. The majority of parents remained hopeful. Hope for a cure was not associated with more long-term traumatic grief or symptoms of depression.

OA12 When grief and work collide.

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Rosenberg, Kathryn

2015-04-01

There is a significant price to pay for organisations that fail to take seriously the challenges involved in supporting grieving employees in the workplace, including loss of productivity, sickness absence, and low morale. The purpose of this study was to look at how social service organisations implement their bereavement policies and support bereaved staff. The study aimed to raise awareness of current issues and practices in the implementation of bereavement policies and the management and support of grieving employees on their return to work. A generic qualitative method was used and recruitment of six participants from social service organisations within New Zealand was undertaken. Non-probability purposive sampling was used. Data collection was via email interviews. While New Zealand employees are legally entitled to three days paid bereavement leave, how flexible and supportive employers were willing to be beyond that varied. Participants felt out of their depth in dealing with grieving employees and lack of training around grief and loss meant a heavy reliance on external sources of support. The study also exposed a possible lack of understanding in relation to cultural mourning rituals. This study uncovered several areas of concern relating to organisational attitudes towards grieving employees and their ability to adequately support bereaved staff on their return to work. It poses the question for future research as to whether organisations can afford not to care and serves as a springboard for examining the detrimental consequences of neglecting the realities of loss. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Pain and pain behavior in burning mouth syndrome: a pain diary study.

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Forssell, Heli; Teerijoki-Oksa, Tuija; Kotiranta, Ulla; Kantola, Rosita; Bäck, Marjaliina; Vuorjoki-Ranta, Tiina-Riitta; Siponen, Maria; Leino, Ari; Puukka, Pauli; Estlander, Ann-Mari

2012-01-01

To characterize pain related to primary burning mouth syndrome (BMS) in terms of intensity, interference, and distress caused by the pain, as well as factors influencing the pain across a period of 2 weeks, and to study the use of coping and management strategies on a daily basis. Fifty-two female patients with primary BMS completed a 2-week pain diary. Pain intensity, interference, distress, and mood on a 0 to 10 numeric rating scale (NRS), as well as pain amplifying and alleviating factors, were recorded three times a day. The use of treatments (medication or other means) and coping strategies were recorded at the end of each day. Coefficient of variation, repeated measures analysis of variance, and correlative methods were used to assess the between- and within-subject variation, pain patterns, and associations between various pain scores. The overall mean pain intensity score of the 14 diary days was 3.1 (SD: 1.7); there was considerable variation in pain intensity between patients. Most patients experienced intermittent pain. On average, pain intensity increased from the morning to the evening. Intercorrelations between pain intensity, interference, distress, and mood were high, varying between rs = .75 and rs = .93 (P < .001). Pungent or hot food or beverages, stress, and tiredness were the most frequently mentioned pain-amplifying factors. The corresponding pain-alleviating factors were eating, sucking pastilles, drinking cold beverages, and relaxation. Thirty (58%) patients used pain medication and 35% reported using other means to alleviate their BMS pain. There was large variation in the use of coping strategies -between subjects. There were considerable differences in pain, in factors influencing the pain, and in pain behavior across BMS patients. This indicates that patient information and education as well as treatment of BMS pain should be individualized.

Pain-relevant anxiety affects desire for pain relief, but not pain perception

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Adriana Banozic

2017-01-01

Full Text Available Background: Pain context plays a significant role in the perception of pain. Despite recent interest in vicarious learning and anxiety in pain modulation, there have been no attempts to explore pain modulation by specific environmental cues. Aims: Therefore, the present study evaluated pain responses in the condition that was attributed as either anxiety relevant (AR or anxiety irrelevant. Materials and Methods: Participants were exposed to both conditions through social observational learning. Pain perception was assessed by means of a visual analog scale ranging from 0 = no pain to 10 = maximum imaginable pain. State anxiety, empathy, expectancy, and desire for pain relief were also measured at both neutral and emotionally inducing conditions. Results: No effect of relevancy of anxiety for the pain context on any of the pain-related constructs was found. However, participants in the AR condition reported an increased desire for pain relief. Maximizing similarities between observed and experienced pain context did not enhance observational learning effects in the emotionally inducing condition regardless of its relevance, but significant changes were found in comparison to the affectively neutral group. Conclusions: These results could have potentially significant clinical implications suggesting that even though observing painful procedures does not increase pain it could affect medication usage.

Efficient conditioned pain modulation despite pain persistence in painful diabetic neuropathy

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Yelena Granovsky

2017-06-01

Conclusion:. Pro-nociception, expressed by less efficient CPM and high temporal summation that usually accompanies clinical painful conditions, seems to “normalize” with chronicity of the pain syndrome. This is despite continuing pain, suggesting that pro-nociceptivity in pain syndromes is multifactorial. Because the pain modulation profile affects success of therapy, this suggests that different drugs might express different efficacy pending on duration of the pain in patients with PDN.

Feminist Pedagogy Meets Feminist Therapy: Teaching Feminist Therapy in Women's Studies

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Magnet, Shoshana; Diamond, Shaindl

2010-01-01

The affective realm--including sorrow, pain, ecstasy, vulnerability, joy, and rage--is a central component of feminist teaching and learning. Feminist classrooms are spaces where strong feelings are raised, paradigms shift, and ruptures are created. Coming to feminist consciousness may involve grief, anger, and sadness for students. Speaking about…

Coping Flexibility and Complicated Grief: A Comparison of American and Chinese Samples

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Burton, Charles L.; Yan, Oscar H.; Pat-Horenczyk, Ruth; Chan, Ide S. F.; Ho, Samuel; Bonanno, George A.

2011-01-01

Background The ability to process a death, and the ability to remain optimistic and look beyond the loss, are both thought to be effective means of coping with loss and other aversive events. Recently, these seemingly contrary dimensions have been integrated into the idea of coping flexibility. Method In this study we assessed the ability of married and bereaved individuals in the US and Hong Kong to use both coping approaches as operationalized by the trauma-focused and forward-focused coping scales of a previously validated questionnaire. We also calculated a single flexibility score. Results Bereaved participants reported greater trauma-focused coping ability than did married participants. However, bereaved participants meeting criteria for complicated grief (CG) reported less forward-focused coping than both asymptomatic bereaved and married participants. The CG group also showed less overall coping flexibility than the asymptomatic bereaved and married groups. Country was not a factor. Conclusions Findings suggest that deficits in coping flexibility are indicative of pathology in bereaved individuals, and that this relationship extends across cultures. Limitations of the study and directions for future research are discussed. PMID:21898713

Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia.

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Gerhardt, Andreas; Eich, Wolfgang; Treede, Rolf-Detlef; Tesarz, Jonas

2017-03-01

Findings considering conditioned pain modulation (CPM) in chronic back pain (CBP) are contradictory. This might be because many patients with CBP report pain in further areas of the body, and altered CPM might influence spatial extent of pain rather than CBP per se. Therefore, we compared CPM in patients with CBP with different pain extent. Patients with fibromyalgia syndrome (FMS), for whom CPM impairment is reported most consistently, were measured for comparison. Based on clinical evaluation and pain drawings, patients were categorized into chronic local back pain (CLP; n = 53), chronic widespread back pain (CWP; n = 32), and FMS (n = 92). Conditioned pain modulation was measured by the difference in pressure pain threshold (test stimuli) at the lower back before and after tonic heat pain (conditioning stimulus). We also measured psychosocial variables. Pressure pain threshold was significantly increased in CLP patients after tonic heat pain (P pain modulation in CLP was significantly higher than that in CWP and FMS (P painful areas (0-10) were associated with lower CPM (r = 0.346, P = 0.001) in CBP but not in FMS (r = -0.013, P = 0.903). Anxiety and depression were more pronounced in FMS than in CLP or CWP (P values pain inhibition seem to be more indicated the higher the pain extent.

Painful Intercourse Is Significantly Associated with Evoked Pain Perception and Cognitive Aspects of Pain in Women with Pelvic Pain

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Meryl J. Alappattu, DPT, PhD

2015-03-01

Conclusions: Differences in local pain ratings suggest that women with pelvic pain perceive stimuli in this region as more painful than pain-free women although the magnitude of stimuli does not differ. Alappattu MJ, George SZ, Robinson ME, Fillingim RB, Moawad N, LeBrun EW, and Bishop MD. Painful intercourse is significantly associated with evoked pain perception and cognitive aspects of pain in women with pelvic pain. Sex Med 2015;3:14–23.

Colorectal surgery patients' pain status, activities, satisfaction, and beliefs about pain and pain management.

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Brown, Carolyn; Constance, Kristel; Bédard, Denise; Purden, Margaret

2013-12-01

This study describes surgical colorectal cancer patients' pain levels, recovery activities, beliefs and expectations about pain, and satisfaction with pain management. A convenience sample of 50 adult inpatients who underwent colorectal surgery for cancer participated. Patients were administered the modified American Pain Society Patient Outcome Questionnaire on postoperative day 2 and asked to report on their status in the preceding 24 hours. Patients reported low current (mean 1.70) and average (mean 2.96) pain scores but had higher scores and greater variation for worst pain (mean 5.48). Worst pain occurred mainly while turning in bed or mobilizing, and 25% of patients experienced their worst pain at rest. Overall, patients expected to have pain after surgery and were very satisfied with pain management. Patients with worst pain scores >7 reported interference with recovery activities, mainly general activity (mean 5.67) and walking ability (mean 5.15). These patients were likely to believe that "people can get addicted to pain medication easily" (mean 3.39 out of 5) and that "pain medication should be saved for cases where pain gets worse" (mean 3.20 out of 5). These beliefs could deter patients from seeking pain relief and may need to be identified and addressed along with expectations about pain in the preoperative nursing assessment. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Healing Trauma, Building Resilience: SITCAP in Action

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Steele, William; Kuban, Caelan

2014-01-01

Childhood trauma is marked by an overwhelming sense of terror and powerlessness. Loss of loving relationships is yet another type of trauma that produces the pain of sadness and grief. The resulting symptoms only reflect the neurological, biological, and emotional coping systems mobilized in the struggle to survive. These young people need new…

Dancing in pain: pain appraisal and coping in dancers.

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Anderson, Ruth; Hanrahan, Stephanie J

2008-01-01

This study investigated the relationships between the type of pain experienced (performance pain and injury pain), the cognitive appraisal of pain and pain coping styles in dancers. Fifty-one professional ballet and contemporary dancers (17 males and 34 females), with the mean age of 25.9 years, completed a general pain questionnaire, the Pain Appraisal Inventory, the Survey of Pain Attitudes Control Subscale, and the Sports Inventory for Pain. Multivariate analyses of variance indicated that both the cognitive appraisal of the pain and pain coping styles did not differ according to the type of pain experienced or the pain severity. However, it was found that dancers with performance pain of either low or high severity were more likely to dance in pain than dancers experiencing injury pain. Multiple regression analyses indicated that the appraisal of pain as threatening was predictive of the use of avoidance and catastrophizing pain coping styles. Overall, results indicated that dancers may not differentiate between performance pain and injury pain, or modify their appraisal and coping strategies according to the characteristics of the pain experienced. The study highlighted an opportunity for increased education for dancers in recognizing the difference between pain considered to be a routine aspect of training and pain which is a signal of serious injury.

Fear of pain in children and adolescents with neuropathic pain and complex regional pain syndrome.

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Simons, Laura E

2016-02-01

A significant proportion of children and adolescents with chronic pain endorse elevated pain-related fear. Pain-related fear is associated with high levels of disability, depressive symptoms, and school impairment. Because of faulty nerve signaling, individuals with neuropathic pain and complex regional pain syndrome may be more prone to develop pain-related fear as they avoid use of and neglect the affected body area(s), resulting in exacerbated symptoms, muscle atrophy, maintenance of pain signaling, and ongoing pain-related disability. Not surprisingly, effective treatments for elevated pain-related fears involve exposure to previously avoided activities to downregulate incorrect pain signaling. In the context of intensive interdisciplinary pain treatment of youth with neuropathic pain, decreasing pain-related fear is associated with improved physical and psychological functioning, whereas high initial pain-related fear is a risk factor for less treatment responsiveness. An innovative approach to targeting pain-related fear and evidence of a neural response to treatment involving decoupling of the amygdala with key fear circuits in youth with complex regional pain syndrome suggest breakthroughs in our ability to ameliorate these issues.

Spontaneous pain attacks: neuralgic pain

NARCIS (Netherlands)

de Bont, L.G.

2006-01-01

Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either

Effect of counseling quality on anxiety, grief, and coping after second-trimester abortion for pregnancy complications.

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Kerns, Jennifer L; Mengesha, Biftu; McNamara, Blair C; Cassidy, Arianna; Pearlson, Geffan; Kuppermann, Miriam

2018-06-01

We sought to explore the relationship between counseling quality, measured by shared decision making and decision satisfaction, and psychological outcomes (anxiety, grief, and posttraumatic stress) after second-trimester abortion for pregnancy complications. We conducted a cross-sectional study of women who underwent second-trimester abortion for complications. We recruited participants from Facebook and online support groups and surveyed them about counseling experiences and psychosocial issues. We used multivariate linear regression to evaluate relationships between counseling quality and psychological outcomes. We analyzed data from 145 respondents. Shared decision making and decision satisfaction scores were positively and strongly correlated in bivariate analysis (r=0.7, pCounseling quality may be especially important in this setting given the sensitive nature of decisions regarding pregnancy termination for complications. These results highlight the importance of patient-centered counseling for women seeking pregnancy termination. Copyright © 2018. Published by Elsevier Inc.

Pain-related worry in patients with chronic orofacial pain.

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Davis, C Ervin; Stockstill, John W; Stanley, William D; Wu, Qiang

2014-07-01

Pain-related worry is distinct from, but related to, pain catastrophizing (PC) and anxiety. Worry and its relationship with other variables have been studied in people with chronic pain but not in people with chronic orofacial pain. The authors explored the prevalence of trait, general and pain-related worry and the association of worry with higher pain levels and other variables. The authors assessed people who had a diagnosis of chronic orofacial pain by using nonpain-related trait worry, state anxiety, trait anxiety, PC and pain measures. The participants' answers to an open-ended question about what they were most worried about led to the identification of worry domains, including worry about pain. The authors found that worrying about pain was related significantly to worst and least pain levels, pain interference and pain duration, as well as moderated trait worry in predicting pain interference. Although trait worry was not correlated directly with pain, when moderated by PC, it made substantial contributions in predicting pain interference. Participants with chronic orofacial pain reported experiencing substantial levels of trait worry, anxiety, PC and worry about pain that related to pain ratings directly and indirectly. Clinicians should assess pain-related worry in patients with chronic orofacial pain to understand the effects of worry on pain and functioning. Clinicians could treat these patients more effectively by helping them reduce their levels of pain-related worry and focusing on improved coping.

Pain Adaptability in Individuals With Chronic Musculoskeletal Pain Is Not Associated With Conditioned Pain Modulation.

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Wan, Dawn Wong Lit; Arendt-Nielsen, Lars; Wang, Kelun; Xue, Charlie Changli; Wang, Yanyi; Zheng, Zhen

2018-03-27

Healthy humans can be divided into the pain adaptive (PA) and the pain nonadaptive (PNA) groups; PA showed a greater decrease in pain rating to a cold pressor test (CPT) than PNA. This study examined if the dichotomy of pain adaptability existed in individuals with chronic musculoskeletal pain. CPTs at 2°C and 7°C were used to assess the status of pain adaptability in participants with either chronic nonspecific low back pain or knee osteoarthritis. The participants' potency of conditioned pain modulation (CPM) and local inhibition were measured. The strengths of pain adaptability at both CPTs were highly correlated. PA and PNA did not differ in their demographic characteristics, pain thresholds from thermal and pressure stimuli, or potency of local inhibition or CPM. PA reached their maximum pain faster than PNA (t 41 = -2.76, P adaptability exists in musculoskeletal pain patients. Consistent with the healthy human study, the strength of pain adaptability and potency of CPM are not related. Pain adaptability could be another form of endogenous pain inhibition of which clinical implication is yet to be understood. The dichotomy of pain adaptability was identified in healthy humans. The current study confirms that this dichotomy also exists in individuals with chronic musculoskeletal pain, and could be reliably assessed with CPTs at 2°C and 7°C. Similar to the healthy human study, pain adaptability is not associated with CPM, and may reflect the temporal aspect of pain inhibition. Copyright © 2018 The American Pain Society. Published by Elsevier Inc. All rights reserved.

Maintenance of Pain in Children With Functional Abdominal Pain.

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Czyzewski, Danita I; Self, Mariella M; Williams, Amy E; Weidler, Erica M; Blatz, Allison M; Shulman, Robert J

2016-03-01

A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdominal pain frequency and compared the predictive value of 3 methods for assessing pain-stooling relations (ie, diary, parent report, child report). Seventy-six children (7-10 years old at baseline) who presented for medical treatment of functional abdominal pain were followed up 18 to 24 months later. Baseline anxiety and abdominal pain-stooling relations based on pain and stooling diaries and child- and parent questionnaires were examined in relationship to the persistence of abdominal pain frequency. Children's baseline anxiety was not related to persistence of pain frequency. Children who, however, displayed irritable bowel syndrome (IBS) symptoms at baseline maintained pain frequency at follow-up, whereas in children in whom there was no relationship between pain and stooling, pain frequency decreased. Pain and stool diaries and parent report of pain-stooling relations were predictive of pain persistence but child-report questionnaires were not. The presence of IBS symptoms in school-age children with functional abdominal pain appears to predict persistence of abdominal pain over time, whereas anxiety does not. Prospective pain and stooling diaries and parent report of IBS symptoms were predictors of pain maintenance, but child report of symptoms was not.

Altering gender role expectations: effects on pain tolerance, pain threshold, and pain ratings.

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Robinson, Michael E; Gagnon, Christine M; Riley, Joseph L; Price, Donald D

2003-06-01

The literature demonstrating sex differences in pain is sizable. Most explanations for these differences have focused on biologic mechanisms, and only a few studies have examined social learning. The purpose of this study was to examine the contribution of gender-role stereotypes to sex differences in pain. This study used experimental manipulation of gender-role expectations for men and women. One hundred twenty students participated in the cold pressor task. Before the pain task, participants were given 1 of 3 instructional sets: no expectation, 30-second performance expectation, or a 90-second performance expectation. Pain ratings, threshold, and tolerance were recorded. Significant sex differences in the "no expectation" condition for pain tolerance (t = 2.32, df = 38, P differ in their pain tolerance, pain threshold, or pain ratings. This is the first empirical study to show that manipulation of expectations alters sex differences in laboratory pain.

Predicting postoperative pain by preoperative pressure pain assessment.

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Hsu, Yung-Wei; Somma, Jacques; Hung, Yu-Chun; Tsai, Pei-Shan; Yang, Chen-Hsien; Chen, Chien-Chuan

2005-09-01

The goal of this study was to evaluate whether preoperative pressure pain sensitivity testing is predictive of postoperative surgical pain. Female subjects undergoing lower abdominal gynecologic surgery were studied. A pressure algometer was used preoperatively to determine the pressure pain threshold and tolerance. A visual analog scale (VAS) was used to assess postoperative pain. A State-Trait Anxiety Inventory was used to assess patients' anxiety. Subjects received intravenous patient-controlled analgesia for postoperative pain control. The preoperative pain threshold and tolerance were compared with the postoperative VAS pain score and morphine consumption. Forty women were enrolled. Their preoperative pressure pain threshold and tolerance were 141 +/- 65 kPa and 223 +/- 62 kPa, respectively. The VAS pain score in the postanesthesia care unit and at 24 h postoperatively were 81 +/- 24 and 31 +/- 10, respectively. Highly anxious patients had higher VAS pain scores in the postanesthesia care unit (P pain tolerance was significantly correlated with the VAS at 24 h postoperatively (P pain tolerance after fentanyl administration (mean, 272 +/- 68 kPa) correlated significantly with morphine consumption in the first 24 h postoperatively (P pain tolerance is significantly correlated with the level of postoperative pain. Pain tolerance assessment after fentanyl was administered and fentanyl sensitivity predicted the dose of analgesics used in the first 24 h after surgery. The algometer is thus a simple, useful tool for predicting postoperative pain and analgesic consumption.

Pain and the ethics of pain management.

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Edwards, R B

1984-01-01

In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern.

Improvement of burn pain management through routine pain monitoring and pain management protocol.

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Yang, Hyeong Tae; Hur, Giyeun; Kwak, In-Suk; Yim, Haejun; Cho, Yong Suk; Kim, Dohern; Hur, Jun; Kim, Jong Hyun; Lee, Boung Chul; Seo, Cheong Hoon; Chun, Wook

2013-06-01

Pain management is an important aspect of burn management. We developed a routine pain monitoring system and pain management protocol for burn patients. The purpose of this study is to evaluate the effectiveness of our new pain management system. From May 2011 to November 2011, the prospective study was performed with 107 burn patients. We performed control group (n=58) data analysis and then developed the pain management protocol and monitoring system. Next, we applied our protocol to patients and performed protocol group (n=49) data analysis, and compared this to control group data. Data analysis was performed using the Numeric Rating Scale (NRS) of background pain and procedural pain, Clinician-Administered PTSD Scale (CAPS), Hamilton Depression Rating Scale (HDRS), State-Trait Anxiety Inventory Scale (STAIS), and Holmes and Rahe Stress Scale (HRSS). The NRS of background pain for the protocol group was significantly decreased compared to the control group (2.8±2.0 versus 3.9±1.9), and the NRS of procedural pain of the protocol group was significantly decreased compared to the control group (4.8±2.8 versus 3.7±2.5). CAPS and HDRS were decreased in the protocol group, but did not have statistical significance. STAIS and HRSS were decreased in the protocol group, but only the STAIS had statistical significance. Our new pain management system was effective in burn pain management. However, adequate pain management can only be accomplished by a continuous and thorough effort. Therefore, pain control protocol and pain monitoring systems need to be under constant revision and improvement using creative ideas and approaches. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

Characterizing individual painDETECT symptoms by average pain severity

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Sadosky A

2016-07-01

Full Text Available Alesia Sadosky,1 Vijaya Koduru,2 E Jay Bienen,3 Joseph C Cappelleri4 1Pfizer Inc, New York, NY, 2Eliassen Group, New London, CT, 3Outcomes Research Consultant, New York, NY, 4Pfizer Inc, Groton, CT, USA Background: painDETECT is a screening measure for neuropathic pain. The nine-item version consists of seven sensory items (burning, tingling/prickling, light touching, sudden pain attacks/electric shock-type pain, cold/heat, numbness, and slight pressure, a pain course pattern item, and a pain radiation item. The seven-item version consists only of the sensory items. Total scores of both versions discriminate average pain-severity levels (mild, moderate, and severe, but their ability to discriminate individual item severity has not been evaluated.Methods: Data were from a cross-sectional, observational study of six neuropathic pain conditions (N=624. Average pain severity was evaluated using the Brief Pain Inventory-Short Form, with severity levels defined using established cut points for distinguishing mild, moderate, and severe pain. The Wilcoxon rank sum test was followed by ridit analysis to represent the probability that a randomly selected subject from one average pain-severity level had a more favorable outcome on the specific painDETECT item relative to a randomly selected subject from a comparator severity level.Results: A probability >50% for a better outcome (less severe pain was significantly observed for each pain symptom item. The lowest probability was 56.3% (on numbness for mild vs moderate pain and highest probability was 76.4% (on cold/heat for mild vs severe pain. The pain radiation item was significant (P<0.05 and consistent with pain symptoms, as well as with total scores for both painDETECT versions; only the pain course item did not differ.Conclusion: painDETECT differentiates severity such that the ability to discriminate average pain also distinguishes individual pain item severity in an interpretable manner. Pain

On Mourning and Recovery: Integrating Stages of Grief and Change Toward a Neuroscience-Based Model of Attachment Adaptation in Addiction Treatment.

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Chambers, R Andrew; Wallingford, Sue C

2017-01-01

Interpersonal attachment and drug addiction share many attributes across their behavioral and neurobiological domains. Understanding the overlapping brain circuitry of attachment formation and addiction illuminates a deeper understanding of the pathogenesis of trauma-related mental illnesses and comorbid substance use disorders, and the extent to which ending an addiction is complicated by being a sort of mourning process. Attention to the process of addiction recovery-as a form of grieving-in which Kubler-Ross's stages of grief and Prochaska's stages of change are ultimately describing complementary viewpoints on a general process of neural network and attachment remodeling, could lead to more effective and integrative psychotherapy and medication strategies.

The influence of children's pain memories on subsequent pain experience.

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Noel, Melanie; Chambers, Christine T; McGrath, Patrick J; Klein, Raymond M; Stewart, Sherry H

2012-08-01

Healthy children are often required to repeatedly undergo painful medical procedures (eg, immunizations). Although memory is often implicated in children's reactions to future pain, there is a dearth of research directly examining the relationship between the 2. The current study investigated the influence of children's memories for a novel pain stimulus on their subsequent pain experience. One hundred ten healthy children (60 boys) between the ages of 8 and 12 years completed a laboratory pain task and provided pain ratings. Two weeks later, children provided pain ratings based on their memories as well as their expectancies about future pain. One month following the initial laboratory visit, children again completed the pain task and provided pain ratings. Results showed that children's memory of pain intensity was a better predictor of subsequent pain reporting than their actual initial reporting of pain intensity, and mediated the relationship between initial and subsequent pain reporting. Children who had negatively estimated pain memories developed expectations of greater pain prior to a subsequent pain experience and showed greater increases in pain ratings over time than children who had accurate or positively estimated pain memories. These findings highlight the influence of pain memories on healthy children's expectations of future pain and subsequent pain experiences and extend predictive models of subsequent pain reporting. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Pain adaptability in individuals with chronic musculoskeletal pain is not associated with conditioned pain modulation

DEFF Research Database (Denmark)

Wan, Dawn Wong Lit; Arendt-Nielsen, Lars; Wang, Kelun

2018-01-01

(MSK). CPTs at 2°C and 7°C were used to assess the status of pain adaptability in participants with either chronic non-specific low back pain or knee osteoarthritis. The participants' potency of conditioned pain modulation (CPM) and local inhibition were measured. The strengths of pain adaptability...... at both CPTs were highly correlated. PA and PNA did not differ in their demographics, pain thresholds from thermal and pressure stimuli, or potency of local inhibition or CPM. PA reached their maximum pain faster than PNA (t41=-2.76, p... days whereas PNA did not (F (6,246) = 3.01, p = 0.01). The dichotomy of pain adaptability exists in MSK patients. Consistent with the healthy human study, the strength of pain adaptability and potency of CPM are not related. Pain adaptability could be another form of endogenous pain inhibition which...

Pain Control After Surgery: Pain Medicines

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... Emotional Well-Being Mental Health Sex and Birth Control Sex and Sexuality Birth Control Family Health Infants and Toddlers Kids and Teens ... Bracing: What Works? Home Prevention and Wellness Pain Control After Surgery: Pain Medicines Pain Control After Surgery: ...

Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients.

NARCIS (Netherlands)

Roelofs, J.; Peters, M.L.; Patijn, J.; Schouten, E.G.; Vlaeyen, J.W.

2004-01-01

The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40

Altered Pain Sensitivity in Elderly Women with Chronic Neck Pain

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Uthaikhup, Sureeporn; Prasert, Romchat; Paungmali, Aatit; Boontha, Kritsana

2015-01-01

Background Age-related changes occur in both the peripheral and central nervous system, yet little is known about the influence of chronic pain on pain sensitivity in older persons. The aim of this study was to investigate pain sensitivity in elders with chronic neck pain compared to healthy elders. Methods Thirty elderly women with chronic neck pain and 30 controls were recruited. Measures of pain sensitivity included pressure pain thresholds, heat/cold pain thresholds and suprathreshold heat pain responses. The pain measures were assessed over the cervical spine and at a remote site, the tibialis anterior muscle. Results Elders with chronic neck pain had lower pressure pain threshold over the articular pillar of C5-C6 and decreased cold pain thresholds over the cervical spine and tibialis anterior muscle when compared with controls (p pain thresholds and suprathreshold heat pain responses (p > 0.05). Conclusion The presence of pain hypersensitivity in elderly women with chronic neck pain appears to be dependent on types of painful stimuli. This may reflect changes in the peripheral and central nervous system with age. PMID:26039149

Doubling Your Payoff: Winning Pain Relief Engages Endogenous Pain Inhibition

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Becker, Susanne; Gandhi, Wiebke; Kwan, Saskia; Ahmed, Alysha-Karima; Schweinhardt, Petra

2015-01-01

When in pain, pain relief is much sought after, particularly for individuals with chronic pain. In analogy to augmentation of the hedonic experience ("liking") of a reward by the motivation to obtain a reward ("wanting"), the seeking of pain relief in a motivated state might increase the experience of pain relief when obtained. We tested this hypothesis in a psychophysical experiment in healthy human subjects, by assessing potential pain-inhibitory effects of pain relief "won" in a wheel of fortune game compared with pain relief without winning, exploiting the fact that the mere chance of winning induces a motivated state. The results show pain-inhibitory effects of pain relief obtained by winning in behaviorally assessed pain perception and ratings of pain intensity. Further, the higher participants scored on the personality trait novelty seeking, the more pain inhibition was induced. These results provide evidence that pain relief, when obtained in a motivated state, engages endogenous pain-inhibitory systems beyond the pain reduction that underlies the relief in the first place. Consequently, such pain relief might be used to improve behavioral pain therapy, inducing a positive, perhaps self-amplifying feedback loop of reduced pain and improved functionality.

Afrontar el proceso de duelo To deal with grief

Directory of Open Access Journals (Sweden)

Mª Trinidad Pérez Vallejo

2008-06-01

Full Text Available Ana, con su testimonio y con su vida nos enseña como afrontar los procesos de duelo. La muerte de su esposo se produce en febrero de 2005, este suceso fue probablemente la experiencia más difícil e importante que ha pasado durante sus 74 años de vida. Ana cuidó a su esposo durante la enfermedad con celo, dedicación y sobre todo con mucho amor. Ahora nos cuenta su experiencia para que pueda servir a aliviar a todas aquellas personas que se hallan en una situación semejante, a la vez, que rinde homenaje a su esposo que con su vida llena de salud y vitalidad le enseñó a morir. Ana tiene una vida plena dedicada a ayudar a los más necesitados, y canaliza esa ayuda con la gente de su barrio visitando a los enfermos, a los que se encuentran solos y los que tienen condiciones económicas más adversas.Anne, in her testimony and life, teaches us how to deal with grief. The death of her husband, on February, 2005, was probably the most difficult and important occurance in the 74 years of her life. Anne had cared for her husband with zeal, dedication and most importantly, love. Anne shares her experience with us so that it may help to alleviate those of us who find ourselves in a similar situation, and at the same time, pays homage to her husband who, when he was filled whit health and vitality, taught to die. Now Anne has a full life dedicated to helping the most needy as she channels this help through the people of her neighbourhood, visiting the ill, the lonely and those in the most adverse economic circumstances.

Pain Sensitivity and Pain Catastrophizing are Associated with Persistent Pain and Disability after Lumbar Spine Surgery

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Coronado, Rogelio A.; George, Steven Z.; Devin, Clinton J.; Wegener, Stephen T.; Archer, Kristin R.

2015-01-01

Objective To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. Design Prospective observational cohort study. Setting Academic medical center. Participants Patients (N = 68, mean ± SD age = 57.9 ± 13.1 years, N female = 40 (58.8%)) undergoing spine surgery for a degenerative condition from March 1, 2012 to April 30, 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. Interventions Not applicable. Main Outcome Measure(s) The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥ 4 and Oswestry Disability Index scores ≥ 21 at all postoperative time points. Results From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated with having persistent back pain intensity (OR = 2.0, 95% CI = 1.0; 4.1) after surgery. Increased pain catastrophizing at 6 weeks was associated with having persistent back pain intensity (OR = 1.1, 95% CI = 1.0; 1.2), pain interference (OR = 1.1, 95% CI = 1.0; 1.2), and disability (OR = 1.3, 95% CI = 1.1; 1.4). An interaction effect was not found between pain sensitivity and pain catastrophizing on persistent outcomes (p > 0.05). Conclusion(s) Findings suggest the importance of early postoperative screening for pain sensitivity and pain catastrophizing in order to identify patients at-risk for poor postoperative pain intensity, interference, and/or disability outcomes. Future research should consider the benefit of targeted therapeutic strategies for patients with these postoperative prognostic factors. PMID:26101845

Grief: Coping with the Reminders After a Loss: Grief Doesn't Magically End at a Certain Point After a Loved One's Death

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... at a certain point after a loved one's death. Reminders often bring back the pain of loss. ... return on the anniversary of your loved one's death or other special days throughout the year. These ...

Pain chronification: what should a non-pain medicine specialist know?

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Morlion, Bart; Coluzzi, Flaminia; Aldington, Dominic; Kocot-Kepska, Magdalena; Pergolizzi, Joseph; Mangas, Ana Cristina; Ahlbeck, Karsten; Kalso, Eija

2018-04-12

Pain is one of the most common reasons for an individual to consult their primary care physician, with most chronic pain being treated in the primary care setting. However, many primary care physicians/non-pain medicine specialists lack enough awareness, education and skills to manage pain patients appropriately, and there is currently no clear, common consensus/formal definition of "pain chronification". This article, based on an international Change Pain Chronic Advisory Board meeting which was held in Wiesbaden, Germany, in October 2016, provides primary care physicians/non-pain medicine specialists with a narrative overview of pain chronification, including underlying physiological and psychosocial processes, predictive factors for pain chronification, a brief summary of preventive strategies, and the role of primary care physicians and non-pain medicine specialists in the holistic management of pain chronification. Based on currently available evidence, we propose the following consensus-based definition of pain chronification which provides a common framework to raise awareness among non-pain medicine specialists: "Pain chronification describes the process of transient pain progressing into persistent pain; pain processing changes as a result of an imbalance between pain amplification and pain inhibition; genetic, environmental and biopsychosocial factors determine the risk, the degree, and time-course of chronification." Early intervention plays an important role in preventing pain chronification and, as key influencers in the management of patients with acute pain, it is critical that primary care physicians are equipped with the necessary awareness, education and skills to manage pain patients appropriately.

Pain as social glue: shared pain increases cooperation.

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Bastian, Brock; Jetten, Jolanda; Ferris, Laura J

2014-11-01

Even though painful experiences are employed within social rituals across the world, little is known about the social effects of pain. We examined the possibility that painful experiences can promote cooperation within social groups. In Experiments 1 and 2, we induced pain by asking some participants to insert their hands in ice water and to perform leg squats. In Experiment 3, we induced pain by asking some participants to eat a hot chili pepper. Participants performed these tasks in small groups. We found evidence for a causal link: Sharing painful experiences with other people, compared with a no-pain control treatment, promoted trusting interpersonal relationships by increasing perceived bonding among strangers (Experiment 1) and increased cooperation in an economic game (Experiments 2 and 3). Our findings shed light on the social effects of pain, demonstrating that shared pain may be an important trigger for group formation. © The Author(s) 2014.

Pain-related guilt in low back pain.

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Serbic, Danijela; Pincus, Tamar

2014-12-01

Identifying mechanisms that mediate recovery is imperative to improve outcomes in low back pain (LBP). Qualitative studies suggest that guilt may be such a mechanism, but research on this concept is scarce, and reliable instruments to measure pain-related guilt are not available. We addressed this gap by developing and testing a Pain-related Guilt Scale (PGS) for people with LBP. Two samples of participants with LBP completed the scale and provided data on rates of depression, anxiety, pain intensity, and disability. Three factors were identified using exploratory factor analysis (n=137): "Social guilt," (4 items) relating to letting down family and friends; "Managing condition/pain guilt," (5 items) relating to failing to overcome and control pain; and "Verification of pain guilt," (3 items) relating to the absence of objective evidence and diagnosis. This factor structure was confirmed using confirmatory factor analysis (n=288), demonstrating an adequate to good fit with the data (AGFI=0.913, RMSEA=0.061). The PGS subscales positively correlated with depression, anxiety, pain intensity, and disability. After controlling for depression and anxiety the majority of relationships between the PGS subscales and disability and pain intensity remained significant, suggesting that guilt shared unique variance with disability and pain intensity independent of depression and anxiety. High levels of guilt were reported by over 40% of participants. The findings suggest that pain-related guilt is common and is associated with clinical outcomes. Prospective research is needed to examine the role of guilt as a predictor, moderator, and mediator of patients' outcomes.

Pain Intensity Moderates the Relationship Between Age and Pain Interference in Chronic Orofacial Pain Patients.

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Boggero, Ian A; Geiger, Paul J; Segerstrom, Suzanne C; Carlson, Charles R

2015-01-01

BACKGROUND/STUDY CONTEXT: Chronic pain is associated with increased interference in daily functioning that becomes more pronounced as pain intensity increases. Based on previous research showing that older adults maintain well-being in the face of pain as well as or better than their younger counterparts, the current study examined the interaction of age and pain intensity on interference in a sample of chronic orofacial pain patients. Data were obtained from the records of 508 chronic orofacial pain patients being seen for an initial evaluation from 2008 to 2012. Collected data included age (range: 18-78) and self-reported measures of pain intensity and pain interference. Bivariate correlations and regression models were used to assess for statistical interactions. Regression analyses revealed that pain intensity positively predicted pain interference (R(2) = .35, B = 10.40, SE = 0.62, t(507) = 16.70, p theories, including socioemotional selectivity theory, which posits that as people age, they become more motivated to maximize positive emotions and minimize negative ones. The results highlight the importance of studying the mechanisms older adults use to successfully cope with pain.

Headache attributed to masticatory myofascial pain: impact on facial pain and pressure pain threshold.

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Costa, Y M; Porporatti, A L; Stuginski-Barbosa, J; Bonjardim, L R; Speciali, J G; Conti, P C R

2016-03-01

There is no clear evidence on how a headache attributed to temporomandibular disorder (TMD) can hinder the improvement of facial pain and masticatory muscle pain. The aim of this study was to measure the impact of a TMD-attributed headache on masticatory myofascial (MMF) pain management. The sample was comprised of adults with MMF pain measured according to the revised research diagnostic criteria for temporomandibular disorders (RDC/TMD) and additionally diagnosed with (Group 1, n = 17) or without (Group 2, n = 20) a TMD-attributed headache. Both groups received instructions on how to implement behavioural changes and use a stabilisation appliance for 5 months. The reported facial pain intensity (visual analogue scale--VAS) and pressure pain threshold (PPT--kgf cm(-2)) of the anterior temporalis, masseter and right forearm were measured at three assessment time points. Two-way anova was applied to the data, considering a 5% significance level. All groups had a reduction in their reported facial pain intensity (P 0·100). A TMD-attributed headache in patients with MMF pain does not negatively impact pain management, but does change the pattern for muscle pain improvement. © 2015 John Wiley & Sons Ltd.

A pilot study on the effectiveness of anticipatory grief therapy for elderly facing the end of life.

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Cheng, Joanna Oi-Yue; Lo, Raymond; Chan, Faye; Woo, Jean

2010-01-01

This pilot study evaluates the benefits of anticipatory grief therapy (AGT) for day hospice patients and long-term care (LTC) residents with cancer and non-malignant chronic diseases. Twenty-six elderly people (69.2 percent female; average age 81.8 years) participated in experiential, expressive activities and discussions during AGT. The McGill Quality of Life Questionnaire-Hong Kong version and the 15-item Geriatrics Depression Scale (Chinese version) were administered immediately before and after AGT, and at a four-week follow-up. Focus groups were held to collect qualitative feedback. Significant post-AGT improvements were found in physical (Z = -2.12, p art, perceived benefits of AGT, and comments and suggestions for improving AGT in the future. We conclude that AGT delivered in both day hospice and LTC settings could be acceptable, feasible, and useful for elderly people facing the end of life.

Ubiquitous media in everyday practices of grief and commemoration on children’s graves and online memorial sites

DEFF Research Database (Denmark)

Sandvik, Kjetil; Christensen, Dorthe Refslund

is not allocated to a specific period of time (a time of mourning) but that grieving and the social technologies like media, materiality and ritualization related to it are embedded in everyday life practices and have to be conceived of as processes rather than events that (suddenly) occur and then are over......’s graves in urban cemeteries. It is, however, also similarly apparent in the formation of network and peer-to-peer associations and, not the least, in the establishment of online networks and sites of grief and commemoration on social media. Facebook, Twitter and YouTube are media alive with discussions...... as such (Featherstone 1992, Elias 1998) and in relation to death practices (Gibson 2008). In recent years, media research has contributed to the field of death studies. Mediatization studies have focused on how various societal practices are influenced by media logics (Livingstone 2009, Lundby 2009) including religious...

When pain meets … pain-related choice behavior and pain perception in different goal conflict situations.

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Schrooten, Martien G S; Wiech, Katja; Vlaeyen, Johan W S

2014-11-01

Individuals in pain often face the choice between avoiding pain and pursuing other equally valued goals. However, little is known about pain-related choice behavior and pain perception in goal conflict situations. Seventy-eight healthy volunteers performed a computerized task requiring repeated choices between incompatible options, differing in their effect on probability to receive painful stimulation and money. Depending on group assignment, participants chose between increased pain probability versus decreased money probability (avoidance-avoidance conflict situation); decreased pain probability versus increased money probability (approach-approach conflict situation); or decrease versus increase in both probabilities (double approach/avoidance conflict situation). During the choice task, participants rated painfulness, unpleasantness, threat, and fearfulness associated with the painful stimulation and how they felt. Longer choice latency and more choice switching were associated with higher retrospective ratings of conflict and of decision difficulty, and more equal importance placed on pain avoidance and earning money. Groups did not differ in choice behavior, pain stimulus ratings, or affect. Across groups, longer choice latencies were nonsignificantly associated with higher pain, unpleasantness, threat, and fearfulness. In the avoidance-avoidance group, more choice switching was associated with higher pain-related threat and fearfulness, and with more negative affect. These results of this study suggest that associations between choice behaviors, pain perception, and affect depend on conflict situation. We present a first experimental demonstration of the relationship between pain-related choice behaviors, pain, and affect in different goal conflict situations. This experimental approach allows us to examine these relationships in a controlled fashion. Better understanding of pain-related goal conflicts and their resolution may lead to more effective pain

[Pain and Christianity. A symbol for overcoming pain?].

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Markschies, C

2007-08-01

Pain and Christianity appear to belong together: Christ's pain stands at the centre of God's healing; his pain leads to the salvation of mankind. We can learn from Jesus' example how to bear suffering and pain. In early Christian times, the belief that Jesus Christ suffered pain on the cross was usually not accepted. In line with the "apathy axiom", freedom from emotion was something to strive for at that time. Only after the acceptance of Christianity as the state religion of the Roman Empire in 380 AD did the pain of Christ again stand in the centre of the Christian doctrine of salvation. The memory of the fact that Jesus himself had to undergo the worst pain can still help people to overcome their pain and comfort them.

Competing effects of pain and fear of pain on postural control in low back pain?

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Mazaheri, M.; Heidari, E.; Mostmand, J.; Negahban, H.; van Dieen, J.H.

2014-01-01

STUDY DESIGN. A cross-sectional, observational study. OBJECTIVE. To determine whether pain and fear of pain have competing effects on postural sway in patients with low back pain (LBP). SUMMARY OF BACKGROUND DATA. Competing effects of pain and pain-related fear on postural control can be proposed as

The temporal relationship between change in symptoms of prolonged grief and posttraumatic stress following old age spousal bereavement

DEFF Research Database (Denmark)

O Connor, Maja; Nickerson, Angela; Aderka, Idan M.

2015-01-01

Background: High levels of both prolonged grief symptoms (PGS) and posttraumatic stress symptoms (PTSS) are relatively common following bereavement, and the two types of bereavement complications share some of the same features. Little research has studied which of the two precedes the other...... following the death of a loved one. The purpose of this study was to examine the temporal relationship between change in high levels of PGS and PTSS during the first four years following old age spousal loss. Methods: Participants were 237 Danes (40% male; mean age = 73 years, SD = 4.4; range 65-81) who....... Results: Lower-level mediation analyses wereas performed. Results indicated that PGS mediated 83% of the relationship between time and PTSS, while PTSS only mediated 17% of the relationship between time and PGS. These results suggest that changes in PGS mediated changes in PTSS following spousal...

Menopause affects pain depending on pain type and characteristics.

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Meriggiola, Maria Cristina; Nanni, Michela; Bachiocco, Valeria; Vodo, Stellina; Aloisi, Anna M

2012-05-01

Women are more affected than men by many chronic pain conditions, suggesting the effect of sex-related mechanisms in their occurrence. The role of gonadal hormones has been studied but with contrasting results depending on the pain syndrome, reproductive status, and hormone considered. The aim of the present study was to evaluate the pain changes related to the menopausal transition period. In this observational study, postmenopausal women were asked to evaluate the presence of pain in their life during the premenopausal and postmenopausal periods and its modification with menopause. One hundred one women were enrolled and completed questionnaires on their sociodemographic status, pain characteristics, and evolution. The most common pain syndromes were headache (38%), osteoarticular pain (31%), and cervical/lumbar pain (21%). Pain was present before menopause in 66 women, ceased with menopause in 17, and started after menopause in 18. Data were used for cluster analysis, which allowed the division of participants into four groups. In the first, all women experienced headaches that disappeared or improved with menopause. The second group included osteoarticular pain; the pain improved in half of these women and remained stable in the other half. The third group had cervical/lumbar pain, which disappeared or improved with menopause in all. The fourth group presented different kinds of moderate pain, which worsened in all. The present study provides preliminary data suggesting that menopause can affect pain depending on the painful condition experienced by the woman. This underlines the different interactions of menopause-related events with body structures involved in pain.

Pain perception and modulation in acute and chronic pain states

NARCIS (Netherlands)

Oudejans, L.C.J.

2016-01-01

This thesis describes the evaluation of pain perception in acute and chronic pain patients and the strength of the endogenous pain modulation system in chronic pain patients. Additionally, pain phenotypes are determined in patients with chronic pain. The ability of patients with acute pain after

The periodontal pain paradox: Difficulty on pain assesment in dental patients (The periodontal pain paradox hypothesis

Directory of Open Access Journals (Sweden)

Haryono Utomo

2006-12-01

Full Text Available In daily dental practice, the majority of patients’ main complaints are related to pain. Most patients assume that all pains inside the oral cavity originated from the tooth. One particular case is thermal sensitivity; sometimes patients were being able to point the site of pain, although there is neither visible caries nor secondary caries in dental radiograph. In this case, gingival recession and dentin hypersensitivity are first to be treated to eliminate the pain. If these treatments failed, pain may misdiagnose as pulpal inflammation and lead to unnecessary root canal treatment. Study in pain during periodontal instrumentation of plaque-related periodontitis revealed that the majority of patients feel pain and discomfort during probing and scaling. It seems obvious because an inflammation, either acute or chronic is related to a lowered pain threshold. However, in contrast, in this case report, patient suffered from chronic gingivitis and thermal sensitivity experienced a relative pain-free sensation during probing and scaling. Lowered pain threshold which accompanied by a blunted pain perception upon periodontal instrumentation is proposed to be termed as the periodontal pain paradox. The objective of this study is to reveal the possibility of certain factors in periodontal inflammation which may involved in the periodontal pain paradox hypothesis. Patient with thermal hypersensitivity who was conducted probing and scaling, after the relative pain-free instrumentation, thermal hypersensitivity rapidly disappeared. Based on the successful periodontal treatment, it is concluded that chronic gingivitis may modulate periodontal pain perception which termed as periodontal pain paradox

Pain Scores Are Not Predictive of Pain Medication Utilization

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Suzanne Galloway

2011-01-01

Full Text Available Objective. To compare Visual Analogue Scale (VAS scores with overall postoperative pain medication requirements including cumulative dose and patterns of medication utilization and to determine whether VAS scores predict pain medication utilization. Methods. VAS scores and pain medication data were collected from participants in a randomized trial of the utility of phenazopyridine for improved pain control following gynecologic surgery. Results. The mean age of the 219 participants was 54 (range19 to 94. We did not detect any association between VAS and pain medication utilization for patient-controlled anesthesia (PCA or RN administered (intravenous or oral medications. We also did not detect any association between the number of VAS scores recorded and mean pain scores. Conclusion. Postoperative VAS scores do not predict pain medication use in catheterized women inpatients following gynecologic surgery. Increased pain severity, as reflected by higher VAS scores, is not associated with an increase in pain assessment. Our findings suggest that VAS scores are of limited utility for optimal pain control. Alternative or complimentary methods may improve pain management.

Characterizing neuropathic pain profiles: enriching interpretation of painDETECT

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Cappelleri JC

2016-07-01

Full Text Available Joseph C Cappelleri,1 Vijaya Koduru,2 E Jay Bienen,3 Alesia Sadosky4 1Pfizer Inc, Groton, CT, USA; 2Eliassen Group, New London, CT, USA; 3Outcomes Research Consultant, New York, NY, USA; 4Pfizer Inc, New York, NY, USA Purpose: To psychometrically evaluate painDETECT, a patient-reported screening questionnaire for neuropathic pain (NeP, for discriminating among sensory pain symptoms (burning, tingling/prickling, light touching, sudden pain attacks/electric shock-type pain, cold/heat, numbness, and slight pressure. Methods: The seven-item version of painDETECT provides an overall score that targets only sensory symptoms, while the nine-item version adds responses on two items to the overall score, covering pain course pattern and pain radiation. Both versions have relevance in terms of characterizing broad NeP. The nine- and seven-item versions of painDETECT were administered to subjects with confirmed NeP across six conditions identified during office visits to US community-based physicians. Responses on the sensory symptom items were dichotomized into “at least moderate” (ie, moderate, strongly, very strongly relative to the combined other responses (never, hardly noticed, slightly. Logistic regression of dichotomized variables on the total painDETECT score provided probabilities of experiencing each symptom across the range of painDETECT scores. Results: Both painDETECT versions discriminated among the symptoms with similar probabilities across the score ranges. Using these data, the probability of moderately experiencing each pain sensory item was estimated for a particular score, providing a pain profile. Additionally, the likelihood of experiencing each sensation was determined for a discrete increase in score, ie, the odds of at least a moderate sensation of burning (versus less than a moderate sensation was 1.29 for a 1-point increase, 3.52 for a 5-point increase, and 12.42 for every 10-point increase in the nine-item painDETECT score

Dysfunctional pain modulation in somatoform pain disorder patients.

Science.gov (United States)

Klug, Stefanie; Stefanie, Klug; Anderer, Peter; Peter, Anderer; Saletu-Zyhlarz, Gerda; Gerda, Saletu-Zyhlarz; Freidl, Marion; Marion, Freidl; Saletu, Bernd; Bernd, Saletu; Prause, Wolfgang; Wolfgang, Prause; Aigner, Martin; Martin, Aigner

2011-06-01

To date, pain perception is thought to be a creative process of modulation carried out by an interplay of pro- and anti-nociceptive mechanisms. Recent research demonstrates that pain experience constitutes the result of top-down processes represented in cortical descending pain modulation. Cortical, mainly medial and frontal areas, as well as subcortical structures such as the brain stem, medulla and thalamus seem to be key players in pain modulation. An imbalance of pro- and anti-nociceptive mechanisms are assumed to cause chronic pain disorders, which are associated with spontaneous pain perception without physiologic scaffolding or exaggerated cortical activation in response to pain exposure. In contrast to recent investigations, the aim of the present study was to elucidate cortical activation of somatoform pain disorder patients during baseline condition. Scalp EEG, quantitative Fourier-spectral analyses and LORETA were employed to compare patient group (N = 15) to age- and sex-matched controls (N = 15) at rest. SI, SII, ACC, SMA, PFC, PPC, insular, amygdale and hippocampus displayed significant spectral power reductions within the beta band range (12-30 Hz). These results suggest decreased cortical baseline arousal in somatoform pain disorder patients. We finally conclude that obtained results may point to an altered baseline activity, maybe characteristic for chronic somatoform pain disorder.

Spinal pain

International Nuclear Information System (INIS)

Izzo, R.; Popolizio, T.; D’Aprile, P.; Muto, M.

2015-01-01

Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

Spinal pain

Energy Technology Data Exchange (ETDEWEB)

Izzo, R., E-mail: roberto1766@interfree.it [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: t.popolizio1@gmail.com [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: paoladaprile@yahoo.it [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)

2015-05-15

Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

Reward and motivation in pain and pain relief

Science.gov (United States)

Navratilova, Edita; Porreca, Frank

2015-01-01

Pain is fundamentally unpleasant, a feature that protects the organism by promoting motivation and learning. Relief of aversive states, including pain, is rewarding. The aversiveness of pain, as well as the reward from relief of pain, is encoded by brain reward/motivational mesocorticolimbic circuitry. In this Review, we describe current knowledge of the impact of acute and chronic pain on reward/motivation circuits gained from preclinical models and from human neuroimaging. We highlight emerging clinical evidence suggesting that anatomical and functional changes in these circuits contribute to the transition from acute to chronic pain. We propose that assessing activity in these conserved circuits can offer new outcome measures for preclinical evaluation of analgesic efficacy to improve translation and speed drug discovery. We further suggest that targeting reward/motivation circuits may provide a path for normalizing the consequences of chronic pain to the brain, surpassing symptomatic management to promote recovery from chronic pain. PMID:25254980

Pain and pain tolerance in professional ballet dancers.

Science.gov (United States)

Tajet-Foxell, B; Rose, F D

1995-01-01

Pain experience in sport had been the subject of increasing research in recent years. While sports professionals have generally been found to have higher pain thresholds than control subjects the reasons for this are not entirely clear. The present study seeks to investigate one possible explanatory factor, the importance of the popular image of the physical activity and of the self-image of its participants, by examining pain experience in professional ballet dancers. Like sports professionals, dancers were found to have higher pain and pain tolerance thresholds than age matched controls in the Cold Pressor Test. However, they also reported a more acute experience of the sensory aspects of the pain. Explanations of this apparent paradox are discussed both in terms of the neuroticism scores of the two groups and in terms of the dancers' greater experience of pain and its relationship with physical activity. The results illustrated the importance of using multidimensional measures of pain in this type of investigation. PMID:7788215

Pain genes.

Directory of Open Access Journals (Sweden)

Tom Foulkes

2008-07-01

Full Text Available Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors signal the existence of tissue damage to the central nervous system (CNS, where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception.

Cancer pain management: Basic information for the young pain physicians

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SPS Rana

2011-01-01

Full Text Available Cancer pain is multifactorial and complex. The impact of cancer pain is devastating, with increased morbidity and poor quality of life, if not treated adequately. Cancer pain management is a challenging task both due to disease process as well as a consequence of treatment-related side-effects. Optimization of analgesia with oral opioids, adjuvant analgesics, and advanced pain management techniques is the key to success for cancer pain. Early access of oral opioid and interventional pain management techniques can overcome the barriers of cancer pain, with improved quality of life. With timely and proper anticancer therapy, opioids, nerve blocks, and other non-invasive techniques like psychosocial care, satisfactory pain relief can be achieved in most of the patients. Although the WHO Analgesic Ladder is effective for more than 80% cancer pain, addition of appropriate adjuvant drugs along with early intervention is needed for improved Quality of Life. Effective cancer pain treatment requires a holistic approach with timely assessment, measurement of pain, pathophysiology involved in causing particular type of pain, and understanding of drugs to relieve pain with timely inclusion of intervention. Careful evaluation of psychosocial and mental components with good communication is necessary. Barriers to cancer pain management should be overcome with an interdisciplinary approach aiming to provide adequate analgesia with minimal side-effects. Management of cancer pain should comprise not only a physical component but also psychosocial and mental components and social need of the patient. With risk-benefit analysis, interventional techniques should be included in an early stage of pain treatment. This article summarizes the need for early and effective pain management strategies, awareness regarding pain control, and barriers of cancer pain.

Multidimensional features of pain in patients with chronic neck pain

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Fabianna Resende de Jesus-Moraleida

Full Text Available Abstract Introduction: Chronic neck pain is associated with significant health costs and loss of productivity at work. Objective: to assess pain and disability in individuals with chronic neck pain. Methods: 31 volunteers with chronic neck pain, mean age 29, 65 years, were assessed using the McGill Pain Questionnaire in Brazilian version (Br-MPQ and Neck Disability Index (NDI. The Br-MPQ analysis was performed based on the numerical values associated with the words selected to describe the experience of pain (Pain Rating Index - PRI, and present pain intensity (PPI. NDI was used to evaluate the influence of neck pain in performance of everyday tasks. Finally, we investigated the association between PPI and NDI. Results: PRI revealed that the most significant dimension was the sensory pain (70%, and the number of chosen words was 10 (2,62 out of 20 words. Mean PPI value was 1,23 (0,76 in five points; 40% of participants described pain intensity as moderate. NDI score was 9,77 (3,34, indicating mild disability. There was a positive association between disability and pain intensity (r = 0,36; p =0,046. Pain intensity and duration of pain were not associated. Conclusions: Findings of this study identified important information related to neck pain experienced by patients when suffering from chronic neck pain, moreover, the association between disability and pain intensity reinforces the importance of complementary investigation of these aspects to optimize function in them.

Postoperative pain

DEFF Research Database (Denmark)

Kehlet, H; Dahl, J B

1993-01-01

also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree......Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may...

Alexithymic trait, painful heat stimulation and everyday pain experience

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Olga ePollatos

2015-10-01

Full Text Available Background: Alexithymia was found to be associated with a variety of somatic complaints including somatoform pain symptoms. This study addressed the question of whether the different facets of alexithymia are related to responses in heat pain stimulation and its interrelations with levels of everyday pain as assessed by self report. Methods: In the study, sensitivity to heat pain was assessed in fifty healthy female participants. Alexithymia facets were assessed by the Toronto Alexithymia Scale. Pain threshold and tolerance were determined using a testing the limits procedure. Participants furthermore rated subjective intensities and unpleasantness of tonic heat stimuli (45.5 C to 47.5 C on visual analogue scales and on a questionnaire. Possible confounding with temperature sensitivity and mood was controlled. Everyday pain was assessed by self-report addressing everyday pain frequency, intensity and impairment experienced over the last two months. Results: Main results were that the facets of alexithymia were differentially associated with pain perception. The affective scale difficulties in describing feelings was associated with hyposensitivity to pain as indicated by higher pain tolerance scores. Furthermore, everyday pain frequency was related to increased alexithymia values on the affective scale difficulties in identifying feelings, whereas higher values on the cognitive alexithymia scale externally oriented thinking were related to lower pain impairment and intensity. Conclusions: We conclude that the different facets of alexithymia are related to alternations in pain processing. Further research on clinical samples is necessary to elucidate whether different aspects of alexithymia act as vulnerability factor for the development of pain symptoms.

Chronic Pain

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... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. × ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. ...

Effect of pain chronification and chronic pain on an endogenous pain modulation circuit in rats.

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Miranda, J; Lamana, S M S; Dias, E V; Athie, M; Parada, C A; Tambeli, C H

2015-02-12

We tested the hypothesis that chronic pain development (pain chronification) and ongoing chronic pain (chronic pain) reduce the activity and induce plastic changes in an endogenous analgesia circuit, the ascending nociceptive control. An important mechanism mediating this form of endogenous analgesia, referred to as capsaicin-induced analgesia, is its dependence on nucleus accumbens μ-opioid receptor mechanisms. Therefore, we also investigated whether pain chronification and chronic pain alter the requirement for nucleus accumbens μ-opioid receptor mechanisms in capsaicin-induced analgesia. We used an animal model of pain chronification in which daily subcutaneous prostaglandin E2 (PGE2) injections into the rat's hind paw for 14 days, referred to as the induction period of persistent hyperalgesia, induce a long-lasting state of nociceptor sensitization referred to as the maintenance period of persistent hyperalgesia, that lasts for at least 30 days following the cessation of the PGE2 treatment. The nociceptor hypersensitivity was measured by the shortening of the time interval for the animal to respond to a mechanical stimulation of the hind paw. We found a significant reduction in the duration of capsaicin-induced analgesia during the induction and maintenance period of persistent mechanical hyperalgesia. Intra-accumbens injection of the μ-opioid receptor selective antagonist Cys(2),Tyr(3),Orn(5),Pen(7)amide (CTOP) 10 min before the subcutaneous injection of capsaicin into the rat's fore paw blocked capsaicin-induced analgesia. Taken together, these findings indicate that pain chronification and chronic pain reduce the duration of capsaicin-induced analgesia, without affecting its dependence on nucleus accumbens μ-opioid receptor mechanisms. The attenuation of endogenous analgesia during pain chronification and chronic pain suggests that endogenous pain circuits play an important role in the development and maintenance of chronic pain. Copyright © 2014 IBRO

Sexual pain.

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Boardman, Lori A; Stockdale, Colleen K

2009-12-01

Sexual pain is an underrecognized and poorly treated constellation of disorders that significantly impact affected women and their partners. Recognized as a form of chronic pain, sexual pain disorders are heterogeneous and include dyspareunia (superficial and deep), vaginismus, vulvodynia, vestibulitis, and noncoital sexual pain disorder. Women too often tolerate pain in the belief that this will meet their partners' needs. This article provides a review of the terminology and definition of the condition, theories on the pathophysiology, diagnostic considerations, and recommendations on the management of female sexual pain.

The Fear of Pain Questionnaire (FOPQ): assessment of pain-related fear among children and adolescents with chronic pain.

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Simons, Laura E; Sieberg, Christine B; Carpino, Elizabeth; Logan, Deirdre; Berde, Charles

2011-06-01

An important construct in understanding pain-related disability is pain-related fear. Heightened pain-related fear may result in behavioral avoidance leading to disuse, disability, and depression; whereas confrontation of avoided activities may result in a reduction of fear over time and reengagement with activities of daily living. Although there are several measures to assess pain-related fear among adults with chronic pain, none exist for children and adolescents. The aim of the current study was to develop a new tool to assess avoidance and fear of pain with pediatric chronic pain patients: the Fear of Pain Questionnaire, child report (FOPQ-C), and Fear of Pain Questionnaire, parent proxy report (FOPQ-P). After initial pilot testing, the FOPQ-C and FOPQ-P were administered to 299 youth with chronic pain and their parents at an initial multidisciplinary pain treatment evaluation. The FOPQ demonstrated very strong internal consistency of .92 for the child and parent versions. One-month stability estimates were acceptable and suggested responsivity to change. For construct validity, the FOPQ correlated with generalized anxiety, pain catastrophizing, and somatization. Evidence of criterion-related validity was found with significant associations for the FOPQ with pain, healthcare utilization, and functional disability. These results support the FOPQ as a psychometrically sound measure. Pain-related fear plays an important role in relation to emotional distress and pain-related disability among children and adolescents with chronic pain. Identification of patients with high levels of fear avoidance of pain with the FOPQ will inform how to proceed with psychological and physical therapy interventions for chronic pain. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

Cancer Pain Management Education Rectifies Patients' Misconceptions of Cancer Pain, Reduces Pain, and Improves Quality of Life.

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Koh, Su-Jin; Keam, Bhumsuk; Hyun, Min Kyung; Ju Seo, Jeong; Uk Park, Keon; Oh, Sung Yong; Ahn, Jinseok; Lee, Ja Youn; Kim, JinShil

2018-03-26

More than half of the patients have reported improper management of breakthrough cancer pain. Empirical evidence is lacking concerning the effectiveness of cancer pain education on breakthrough pain control. This study aimed to examine the effects of individual pain education on pain control, use of short-acting analgesics for breakthrough pain, quality of life outcomes, and rectification of patients' misconceptions regarding cancer pain. A quasi-experimental design was used. In total, 176 (102 inpatients and 74 outpatients) and 163 (93 inpatients and 70 outpatients) cancer patients completed questionnaires on pain intensity, quality of life, use of short-acting medication for breakthrough pain, and misconceptions about cancer pain and opioid use before and immediately and/or seven days after individual pain education. The mean age of the participants was 60.9 years (±11.2), and 56.3% were male. The most common cancers were lung cancer (17.0%), colon cancer (15.9%), and breast cancer (12.5%). The subjects' reasons for attrition were conditional deterioration, death, or voluntary withdrawal (N = 13, 7.4%). Following the education, there was a significant reduction in overall pain intensity over 24 hours (P < 0.001). The outpatients showed more use of short-acting analgesics for breakthrough pain. Sleep quality change was most significantly associated with intervention; other quality of life aspects (e.g., general feelings and life enjoyment) also improved. Pain education also significantly reduced misconceptions regarding cancer pain management. The present educational intervention was effective in encouraging short-acting analgesic use for breakthrough pain, improving quality of life outcomes, and rectifying patients' misconceptions about analgesic use.

Google (encore) encore soupçonné d'abus de position dominante : Observations sur la Communication des griefs de la Commission Européenne du 20 avril 2016

OpenAIRE

Mouron , Philippe

2016-01-01

National audience; La Commission, dans cette communication du 20 avril 2016, énonce plusieurs griefs à l'encontre de Google, ceux-ci pouvant faire état d’un abus de position dominante :- les contrats passés avec les fabricants d’appareils mobiles subordonneraient l’octroi de licences pour des applications propriétaires (telles que Playstore) à la préinstallation d’autres applications, dont les plus essentielles pour l’utilisation des smartphones et tablettes (Google Search ou Chrome) ;- ces m...

Pain-related psychological correlates of pediatric acute post-surgical pain

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Pagé MG

2012-11-01

Full Text Available M Gabrielle Pagé,1 Jennifer Stinson,2,3 Fiona Campbell,2,4 Lisa Isaac,2,4 Joel Katz1,4,51Department of Psychology, Faculty of Health, York University, 2Department of Anesthesia and Pain Medicine, Hospital for Sick Children, 3Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 4Department of Anesthesia, Faculty of Medicine, University of Toronto, 5Department of Psychology, Hospital for Sick Children, Toronto, ON, CanadaBackground: Post-surgical pain is prevalent in children, yet is significantly understudied. The goals of this study were to examine gender differences in pain outcomes and pain-related psychological constructs postoperatively and to identify pain-related psychological correlates of acute post-surgical pain (APSP and predictors of functional disability 2 weeks after hospital discharge.Methods: Eighty-three children aged 8–18 (mean 13.8 ± 2.4 years who underwent major orthopedic or general surgery completed pain and pain-related psychological measures 48–72 hours and 2 weeks after surgery.Results: Girls reported higher levels of acute postoperative anxiety and pain unpleasantness compared with boys. In addition, pain anxiety was significantly associated with APSP intensity and functional disability 2 weeks after discharge, whereas pain catastrophizing was associated with APSP unpleasantness.Conclusion: These results highlight the important role played by pain-related psychological factors in the experience of pediatric APSP by children and adolescents.Keywords: acute post-surgical pain, children, adolescents, pain anxiety, pain catastrophizing

The Fear of Movement/Pain in Musculoskeletal Pain-A Review

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Behnam Akhbari

2012-07-01

Full Text Available Objective: To investigate and review psychological influences of pain such as kinesiophobia and pain-related fear on patients with musculoskeletal pain and on rehabilitation outcomes. Materials & Methods: Fear is a universal and powerful emotion and, as a result, it can have a profound impact on human behavior. the fear-motivated behavior has the potential to adversely impact rehabilitation outcomes for patients with musculoskeletal pain. cross-sectional studies consistently documented a positive association between elevated pain-related fear and increased pain intensity and disability. in addition, several longitudinal studies indicated that elevated pain-related fear is a precursor to poor clinical outcomes. existence of catastrophizing in patients effect on the fear of movement/ (reinjury. this fear contributes to avoidance behaviors and subsequent disuse, depression, and disability. it has been established that kinesiophobia plays a negative role in the outcome of the rehabilitation of acute and chronic low back pain, chronic fatigue syndrome and fibromyalgia syndrome. Results: The recent studies suggest that physical therapists should consider the role of pain-related fear and avoidance behaviors in patients' function and they should assess these cognitive and behavioral factors. or (physical therapists should assess pain-related fear when rehabilitating certain individuals with musculoskeletal pain. currently, there is a lot of evidence for the assessment of pain-related fear in patients with musculoskeletal pain. self-report questionnaires are readily available for assessment and investigation of pain-related fear and several studies have found support for their validity and reliability. recent research indicated that besides fear-avoidance responses, endurance-related responses lead to chronic pain via physical overload. the existence of mental kinesiophobia has been established in patients with chronic stress complaints, and this

Differential pain modulation in patients with peripheral neuropathic pain and fibromyalgia.

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Gormsen, Lise; Bach, Flemming W; Rosenberg, Raben; Jensen, Troels S

2017-12-29

Background The definition of neuropathic pain has recently been changed by the International Association for the Study of Pain. This means that conditions such as fibromyalgia cannot, as sometimes discussed, be included in the neuropathic pain conditions. However, fibromyalgia and peripheral neuropathic pain share common clinical features such as spontaneous pain and hypersensitivity to external stimuli. Therefore, it is of interest to directly compare the conditions. Material and methods In this study we directly compared the pain modulation in neuropathic pain versus fibromyalgia by recording responses to a cold pressor test in 30 patients with peripheral neuropathic pain, 28 patients with fibromyalgia, and 26 pain-free age-and gender-matched healthy controls. Patients were asked to rate their spontaneous pain on a visual analog scale (VAS (0-100 mm) immediately before and immediately after the cold pressor test. Furthermore the duration (s) of extremity immersion in cold water was used as a measure of the pain tolerance threshold, and the perceived pain intensity at pain tolerance on the VAS was recorded on the extremity in the water after the cold pressor test. In addition, thermal (thermo tester) and mechanical stimuli (pressure algometer) were used to determine sensory detection, pain detection, and pain tolerance thresholds in different body parts. All sensory tests were done by the same examiner, in the same room, and with each subject in a supine position. The sequence of examinations was the following: (1) reaction time, (2) pressure thresholds, (3) thermal thresholds, and (4) cold pressor test. Reaction time was measured to ensure that psychomotoric inhibitions did not influence pain thresholds. Results Pain modulation induced by a cold pressor test reduced spontaneous pain by 40% on average in neuropathic pain patients, but increased spontaneous pain by 2.6% in fibromyalgia patients. This difference between fibromyalgia and neuropathic pain patients was

Enhanced Brain Responses to Pain-Related Words in Chronic Back Pain Patients and Their Modulation by Current Pain.

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Ritter, Alexander; Franz, Marcel; Puta, Christian; Dietrich, Caroline; Miltner, Wolfgang H R; Weiss, Thomas

2016-08-10

Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations induced by pain-related words in a sample of chronic back pain (CBP) patients experiencing current chronic pain compared to HC. In particular, we were interested in how current pain influences brain activations induced by pain-related adjectives. Subjects viewed pain-related, negative, positive, and neutral words; subjects were asked to generate mental images related to these words during fMRI scanning. Brain activation was compared between CBP patients and HC in response to the different word categories and examined in relation to current pain in CBP patients. Pain-related words vs. neutral words activated a network of brain regions including cingulate cortex and insula in subjects and patients. There was stronger activation in medial and dorsolateral prefrontal cortex (DLPFC) and anterior midcingulate cortex in CPB patients than in HC. The magnitude of activation for pain-related vs. negative words showed a negative linear relationship to CBP patients' current pain. Our findings confirm earlier observations showing that pain-related words activate brain networks similar to noxious stimulation. Importantly, CBP patients show even stronger activation of these structures while merely processing pain-related words. Current pain directly influences on this activation.

Evoked potentials after painful cutaneous electrical stimulation depict pain relief during a conditioned pain modulation.

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Höffken, Oliver; Özgül, Özüm S; Enax-Krumova, Elena K; Tegenthoff, Martin; Maier, Christoph

2017-08-29

Conditioned pain modulation (CPM) evaluates the pain modulating effect of a noxious conditioning stimulus (CS) on another noxious test stimulus (TS), mostly based solely on subjective pain ratings. We used painful cutaneous electrical stimulation (PCES) to induce TS in a novel CPM-model. Additionally, to evaluate a more objective parameter, we recorded the corresponding changes of cortical evoked potentials (PCES-EP). We examined the CPM-effect in 17 healthy subjects in a randomized controlled cross-over design during immersion of the non-dominant hand into 10 °C or 24 °C cold water (CS). Using three custom-built concentric surface electrodes, electrical stimuli were applied on the dominant hand, inducing pain of 40-60 on NRS 0-100 (TS). At baseline, during and after CS we assessed the electrically induced pain intensity and electrically evoked potentials recorded over the central electrode (Cz). Only in the 10 °C-condition, both pain (52.6 ± 4.4 (baseline) vs. 30.3 ± 12.5 (during CS)) and amplitudes of PCES-EP (42.1 ± 13.4 μV (baseline) vs. 28.7 ± 10.5 μV (during CS)) attenuated during CS and recovered there after (all p pain ratings during electrical stimulation and amplitudes of PCES-EP correlated significantly with each other (r = 0.5) and with CS pain intensity (r = 0.5). PCES-EPs are a quantitative measure of pain relief, as changes in the electrophysiological response are paralleled by a consistent decrease in subjective pain ratings. This novel CPM paradigm is a feasible method, which could help to evaluate the function of the endogenous pain modulation processes. German Clinical Trials Register DRKS-ID: DRKS00012779 , retrospectively registered on 24 July 2017.

African Americans' Perceptions of Pain and Pain Management: A Systematic Review.

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Booker, Staja Q

2016-01-01

The purpose of this systematic review is to explore the perceptions of acute, persistent, and disease-specific pain and treatment options held by adult African Americans. Underassessment and undermanagement of pain in African Americans has been well documented; however, the cultural continuum of pain perceptions and their influence on pain assessment and management has not been synthesized. Electronic database searches of the Cumulative Index for Nursing and Allied Health Literature and PubMed, Web-based searches of the pain-specific journals plus a manual search of reference lists identified 41 relevant articles addressing perceptions of pain and/or pain management. Analysis of the literature revealed six themes: (a) meaning of pain, (b) description of pain, (c) coping with pain, (d) impact of pain, (e) patient-provider relationship, and (f) treatment approaches. These findings warrant further research and indicate the need for more precise evaluation of pain in African Americans, highlighting an imperative to incorporate cultural patterns into pain management practice and education. © The Author(s) 2014.

Food-Derived Natural Compounds for Pain Relief in Neuropathic Pain.

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Lim, Eun Yeong; Kim, Yun Tai

2016-01-01

Neuropathic pain, defined as pain caused by a lesion or disease of the somatosensory nervous system, is characterized by dysesthesia, hyperalgesia, and allodynia. The number of patients with this type of pain has increased rapidly in recent years. Yet, available neuropathic pain medicines have undesired side effects, such as tolerance and physical dependence, and do not fully alleviate the pain. The mechanisms of neuropathic pain are still not fully understood. Injury causes inflammation and immune responses and changed expression and activity of receptors and ion channels in peripheral nerve terminals. Additionally, neuroinflammation is a known factor in the development and maintenance of neuropathic pain. During neuropathic pain development, the C-C motif chemokine receptor 2 (CCR2) acts as an important signaling mediator. Traditional plant treatments have been used throughout the world for treating diseases. We and others have identified food-derived compounds that alleviate neuropathic pain. Here, we review the natural compounds for neuropathic pain relief, their mechanisms of action, and the potential benefits of natural compounds with antagonistic effects on GPCRs, especially those containing CCR2, for neuropathic pain treatment.

Pain-related anxiety influences pain perception differently in men and women: a quantitative sensory test across thermal pain modalities.

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Thibodeau, Michel A; Welch, Patrick G; Katz, Joel; Asmundson, Gordon J G

2013-03-01

The sexes differ with respect to perception of experimental pain. Anxiety influences pain perception more in men than in women; however, there lacks research exploring which anxiety constructs influence pain perception differentially between men and women. Furthermore, research examining whether depression is associated with pain perception differently between the sexes remains scant. The present investigation was designed to examine how trait anxiety, pain-related anxiety constructs (ie, fear of pain, pain-related anxiety, anxiety sensitivity), and depression are associated with pain perception between the sexes. A total of 95 nonclinical participants (55% women) completed measures assessing the constructs of interest and participated in quantitative sensory testing using heat and cold stimuli administered by a Medoc Pathway Pain and Sensory Evaluation System. The findings suggest that pain-related anxiety constructs, but not trait anxiety, are associated with pain perception. Furthermore, these constructs are associated with pain intensity ratings in men and pain tolerance levels in women. This contrasts with previous research suggesting that anxiety influences pain perception mostly or uniquely in men. Depression was not systematically associated with pain perception in either sex. Systematic relationships were not identified that allow conclusions regarding how fear of pain, pain-related anxiety, and anxiety sensitivity may contribute to pain perception differentially in men and women; however, anxiety sensitivity was associated with increased pain tolerance, a novel finding needing further examination. The results provide directions for future research and clinical endeavors and support that fear and anxiety are important features associated with hyperalgesia in both men and women. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Suprathreshold Heat Pain Response Predicts Activity-Related Pain, but Not Rest-Related Pain, in an Exercise-Induced Injury Model

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Coronado, Rogelio A.; Simon, Corey B.; Valencia, Carolina; Parr, Jeffrey J.; Borsa, Paul A.; George, Steven Z.

2014-01-01

Exercise-induced injury models are advantageous for studying pain since the onset of pain is controlled and both pre-injury and post-injury factors can be utilized as explanatory variables or predictors. In these studies, rest-related pain is often considered the primary dependent variable or outcome, as opposed to a measure of activity-related pain. Additionally, few studies include pain sensitivity measures as predictors. In this study, we examined the influence of pre-injury and post-injury factors, including pain sensitivity, for induced rest and activity-related pain following exercise induced muscle injury. The overall goal of this investigation was to determine if there were convergent or divergent predictors of rest and activity-related pain. One hundred forty-three participants provided demographic, psychological, and pain sensitivity information and underwent a standard fatigue trial of resistance exercise to induce injury of the dominant shoulder. Pain at rest and during active and resisted shoulder motion were measured at 48- and 96-hours post-injury. Separate hierarchical models were generated for assessing the influence of pre-injury and post-injury factors on 48- and 96-hour rest-related and activity-related pain. Overall, we did not find a universal predictor of pain across all models. However, pre-injury and post-injury suprathreshold heat pain response (SHPR), a pain sensitivity measure, was a consistent predictor of activity-related pain, even after controlling for known psychological factors. These results suggest there is differential prediction of pain. A measure of pain sensitivity such as SHPR appears more influential for activity-related pain, but not rest-related pain, and may reflect different underlying processes involved during pain appraisal. PMID:25265560

Enhanced Brain Responses to Pain-Related Words in Chronic Back Pain Patients and Their Modulation by Current Pain

OpenAIRE

Ritter, Alexander; Franz, Marcel; Puta, Christian; Dietrich, Caroline; Miltner, Wolfgang H. R.; Weiss, Thomas

2016-01-01

Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations induced by pain-related words in a sample of chronic back pain (CBP) patients experiencing current chronic pain compared to HC. In particular, we were interested in how current pain influences brain acti...

PAIN INTENSITY AND PAIN INTERFERENCE AMONG TRAUMA PATIENTS: A LITERATURE REVIEW

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Deya Prastika

2016-12-01

Full Text Available Background: The incidence of trauma has been high and has gained attention worldwide. The energy involved in trauma results in specific tissue damage. Such tissue damage generally leads to pain. The high pain intensity possibly is consequence of trauma due to transfer energy to the body from external force and absorbed in wide area. This pain affected patients’ physical and psychological function, in which well known as pain interference. Objective: The aim of this review is to describe the pain intensity and pain interference among trauma patients. Method: A systematic search of electronic databases (CINHAL, ProQuest, Science Direct, and Google scholar was conducted for quantitative and qualitative studies measuring pain intensity and pain interference. The search limited to hospitalized trauma patients in adult age. Results: The search revealed 678 studies. A total of 10 descriptive studies examined pain intensity and pain interference and met inclusion criteria. The pain intensity and pain interference was assessed using Brief Pain Inventory (BPI. Pain intensity of hospitalized trauma patients were moderate to severe. These including 6 studies in orthopedic trauma, one study in musculoskeletal, two in studies in combinational between orthopedic and musculoskeletal, and two studies in burn injury. Moreover, the patients also reported pain was relentless & unbearable. In accordance, data showed that pain interference was moderate to severe from six studies. These studies result in vary of functional interference. However, those studies examined pain interference on sleep, enjoyment of life, mood, relationship with other, walking, general activity, and walking. Conclusion: The evidence from 10 studies included in this review indicates that hospitalized trauma patients perceived moderate to severe pain intensity and pain interference. Further research is needed to better evaluate the pain of hospitalized trauma patients.

Effectiveness of Cognitive Behavioral Therapy on Spiritual Well-Being and Emotional Intelligence of the Elderly Mourners

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Abas Solaimani Khashab

2017-04-01

Full Text Available Objective: Grief is one of the most painful experiences of the humans after linking emotions. In the literature of trauma, grief and mourning can be seen on many topics. Intervention and treatment of grief seems necessary as the period of mourning is prolonged. Thus, this study aimed at understanding the effectiveness of cognitive behavioral therapy on spiritual well-being and emotional intelligence in the elderly bereavement.Method: This was an experimental study with pre-and posttest design, and control group. The population of this study was the elderly mourners in city of Ardabil in 15-2014. After conducting clinical interviews and diagnostic tests using the sampling method, 30 elderly mourners selected. Spiritual Well-Being questionnaire and Emotional Intelligence questionnaire were used for data collection. The questionnaire and pretest-posttest were used in this study. Data were analyzed using multivariate analysis of covariance.Results: The results of the data analysis revealed that cognitive behavioral therapy increased spiritual well-being and emotional intelligence of the mourners was not significantly different between the 2 groups (P<0.01. However, the means of Spiritual Well-Being and Emotional Intelligence at pretest was not significant in the intervention group compared with the control group (P>0.05.Conclusion: Method of cognitive behavioral therapy helps confront the emotional drain and grief acceptance, increasing the spiritual well-being and emotional intelligence of the elderly bereavement.‏

Embitterment and bereavement: The Sewol ferry accident example.

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Chae, Jeong-Ho; Huh, Hyu Jung; Choi, Won Joon

2018-01-01

On Wednesday, April 16, 2014, 261 high school students on a field trip died in the sinking of the Sewol ferry. The bereaved family of the Sewol ferry accident experienced one of the most painful traumatic losses such as the sudden death of one's child through an accident. This article reviewed and discussed embitterment related to traumatic loss through the example of the Sewol ferry accident. Embitterment-related issues and problems in coping with the accident that is caused by societal factors were described. In addition, embitterment-related findings of several previous studies based on bereaved families' mental health cohort study were reviewed. Traumatic loss of the human-made ferry accident was accompanied with feelings of being cheated, injustice, incompetence, wrongdoing by a perpetrator, and the destruction of one's belief and value system, causing severe embitterment. Embitterment was related to other mental health problems including depression, anxiety, and complicated grief. Social support and positive individual resource including optimism and wisdom can be helpful for recovery from posttraumatic embitterment. The goal of grief is to remember the decedent, understand the changes created by the loss, and determine how to reinvest in life. Embitterment may disturb the process of grief. Without the management of the embitterment, true grief may not be possible. The breakdown of value systems and severe embitterment should get more attention in future research. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Adaptability to pain is associated with potency of local pain inhibition, but not conditioned pain modulation: a healthy human study.

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Zheng, Zhen; Wang, Kelun; Yao, Dongyuan; Xue, Charlie C L; Arendt-Nielsen, Lars

2014-05-01

This study investigated the relationship between pain sensitivity, adaptability, and potency of endogenous pain inhibition, including conditioned pain modulation (CPM) and local pain inhibition. Forty-one healthy volunteers (20 male, 21 female) received conditioning stimulation (CS) over 2 sessions in a random order: tonic heat pain (46 °C) on the right leg for 7 minutes and cold pressor pain (1 °C to 4 °C) on the left hand for 5 minutes. Participants rated the intensity of pain continuously using a 0 to 10 electronic visual analogue scale. The primary outcome measures were pressure pain thresholds (PPT) measured at the heterotopic and homotopic location to the CS sites before, during, and 20 minutes after CS. Two groups of participants, pain adaptive and pain nonadaptive, were identified based on their response to pain in the cold pressor test. Pain-adaptive participants showed a pain reduction between peak pain and pain at end of the test by at least 2 of 10 (n=16); whereas the pain-nonadaptive participants reported unchanged peak pain during 5-minute CS (n=25). Heterotopic PPTs during the CS did not differ between the 2 groups. However, increased homotopic PPTs measured 20 minutes after CS correlated with the amount of pain reduction during CS. These results suggest that individual sensitivity and adaptability to pain does not correlate with the potency of CPM. Adaptability to pain is associated with longer-lasting local pain inhibition. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Biobehavioral pain profile in individuals with chronic spine pain.

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Matteliano, Deborah; Scherer, Yvonne Krall; Chang, Yu-Ping

2014-03-01

Pain in the spine is the most frequently described pain problem in primary care, afflicting at least 54 million Americans. When spinal pain becomes chronic, the prognosis for recovery is poor, often leading to disability and reduced quality of life. Clinical treatment is inadequate, often focusing on physical pathology alone. To improve treatment outcomes for chronic pain as recommended by current guidelines, the Biobehavioral Pain Profile (BPP), which includes six pain response subscales, was developed to guide cognitive behavioral therapy (CBT). The purpose of this study was to describe the BPP in 100 individuals with chronic spine pain and examine the associations between the BPP and important clinical outcomes, including chronic pain, disability, and quality of life. Participants reported a high level of pain, a low quality of life, and a high level of disability despite receiving treatment with opioids. Scores on BPP subscales including evaluating loss of control, past and current experience, physiologic responsivity, and thoughts of disease progression were elevated, indicating a need for CBT. Five of the six BPP subscales had a significant association with quality of life, chronic pain, and disability with the thought of disease progression being a strong factor for most of the clinical outcome variables. By identifying BPP, clinicians can provide appropriate treatments to improve individuals' quality of life and prevent further disability. Further study using the BPP to guide CBT is needed. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Keeping pain in mind: a motivational account of attention to pain.

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Van Damme, Stefaan; Legrain, Valéry; Vogt, Julia; Crombez, Geert

2010-02-01

Attention is a key concept in many theories of pain perception. A clinically popular idea is that pain is more intense in persons who are hypervigilant for or bias their attention to pain information. So far, evidence for such bias in pain patients as compared to healthy persons is inconclusive. Furthermore, studies investigating the effects of distracting attention away from pain have shown contradictory results. In this review, we present a motivational perspective on attentional processing of pain that accounts for these inconclusive research findings. We argue that pain always has to be considered within a context of goal pursuit. From this perspective, two largely unexplored theoretical assumptions are introduced. First, when pain occurs during the pursuit of a certain goal, it may unintentionally capture attention although it is not relevant for the goal. Whether such unintentional attentional capture happens is not only dependent upon the characteristics of the pain but also on the characteristics of the focal goal. Second, attention to pain and pain-related information might be driven by a focal goal related to pain. Attentional processing of pain information will be particularly enhanced when the focal goal is related to pain management (e.g., attempting to gain control). Future research should systematically investigate the role of motivation and goal pursuit in the attentional processing of pain-related information. This motivational perspective offers a powerful framework to explain inter- and intra-individual differences in the deployment of attention to pain-related information.

Bilateral experimental neck pain reorganize axioscapular muscle coordination and pain sensitivity.

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Christensen, S W; Hirata, R P; Graven-Nielsen, T

2017-04-01

Neck pain is a large clinical problem where reorganized trunk and axioscapular muscle activities have been hypothesised contributing to pain persistence and pain hypersensitivity. This study investigated the effects of bilateral experimental neck pain on trunk and axioscapular muscle function and pain sensitivity. In 25 healthy volunteers, bilateral experimental neck pain was induced in the splenius capitis muscles by hypertonic saline injections. Isotonic saline was used as control. In sitting, subjects performed slow, fast and slow-resisted unilateral arm movements before, during and after injections. Electromyography (EMG) was recorded from eight shoulder and trunk muscles bilaterally. Pressure pain thresholds (PPTs) were assessed bilaterally at the neck, head and arm. Data were normalized to the before-measures. Compared with control and post measurements, experimental neck pain caused (1) decreased EMG activity of the ipsilateral upper trapezius muscles during all but slow-resisted down movements (p neck pain reorganized axioscapular and trunk muscle activity together with local hyperalgesia and widespread hypoalgesia indicating that acute neck pain immediately affects trunk and axioscapular function which may affect both assessment and treatment. Bilateral clinical neck pain alters axioscapular muscle coordination but only effects of unilateral experimental neck pain has been investigated. Bilateral experimental neck pain causes task-dependent reorganized axioscapular and trunk muscle activity in addition to widespread decrease in pressure pain sensitivity. © 2016 European Pain Federation - EFIC®.

Cancer Pain Physiology

DEFF Research Database (Denmark)

Falk, Sarah; Bannister, Kirsty; Dickenson, Anthony

2014-01-01

Mechanisms of inflammatory and neuropathic pains have been elucidated and translated to patient care by the use of animal models of these pain states. Cancer pain has lagged behind since early animal models of cancer-induced bone pain were based on the systemic injection of carcinoma cells....... This precluded systematic investigation of specific neuronal and pharmacological alterations that occur in cancer-induced bone pain. In 1999, Schwei et al. described a murine model of cancer-induced bone pain that paralleled the clinical condition in terms of pain development and bone destruction, confined...... to the mouse femur. This model prompted related approaches and we can now state that cancer pain may include elements of inflammatory and neuropathic pains but also unique changes in sensory processing. Cancer induced bone pain results in progressive bone destruction, elevated osteoclast activity...

Pain during mammography: Possible risk factors and ways to alleviate pain

International Nuclear Information System (INIS)

Davey, Belinda

2007-01-01

This article reviews the literature surrounding the issue of pain experienced during mammography. This is an important topic since many women may refuse screening mammograms due to the possibility of a painful examination. It is a difficult area to research since the experience of pain is by nature subjective and the manner by which data have been collected has varied with many different pain assessment instruments being utilised. Accordingly there is wide variation in the degree of pain felt from only slight pain to some women finding it acutely painful. To discover why some women find it so painful certain risk factors that have been associated with painful mammography are explored. There are many of these risk factors but this article concentrates on three main areas: biological, psychological and staff-related. Once the reasons why some women experience such acute pain, ways to ease this may be found. Methods to alleviate painful mammography are suggested and discussed. The article concludes that there is a wide variance in the data collection techniques which could account for the wide variance in the reported pain. More research is required using a validated pain measurement to establish the extent of pain and to establish the effect of this on future compliance

Literature, cinema and history in "Hiroshima Mon Amour"

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Nismária Alves David Barros

2013-06-01

Full Text Available This article analyzes Hiroshima Mon Amour, realization by Alain Resnais divulged in 1959 and ciné-roman by Marguerite Duras published in 1960. Considering the Jeanne-Marie Clerc's theory (2004, we understand that the literature and the cinema are resources of expression that do not establish competition or subordination relations, but they establish complementary relations, they make mutual exchanges for their renewals. They are not the documents on the atomic tragedy of Hiroshima because they congregate historical facts, literary narrative and cinematographic techniques. This ciné-roman and this film displays a revolutionary position of the artistic form to express a critical vision on the world after war. They create a love history and a history of loss, focusing the individual anguish in the plot. Through  the return to the past, using a poetical language, they discloses the pains of the protagonist and the pains of the humanity. Therefore the receiver reflects on himself.

Conditioned pain modulation and situational pain catastrophizing as preoperative predictors of pain following chest wall surgery: a prospective observational cohort study.

Directory of Open Access Journals (Sweden)

Kasper Grosen

Full Text Available Variability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency.Preoperatively, 42 healthy males undergoing funnel chest surgery completed the Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory before undergoing a sequential conditioned pain modulation paradigm. Subsequently, the Pain Catastrophizing Scale was introduced and patients were instructed to reference the conditioning pain while answering. Ratings of movement-evoked pain and consumption of morphine equivalents were obtained during postoperative days 2-5. Pain was reevaluated at six months postoperatively.Patients reporting persistent pain at six months follow-up (n = 15 were not significantly different from pain-free patients (n = 16 concerning preoperative conditioned pain modulation response (Z = 1.0, P = 0.3 or level of catastrophizing (Z = 0.4, P = 1.0. In the acute postoperative phase, situational pain catastrophizing predicted movement-evoked pain, independently of anxiety and depression (β = 1.0, P = 0.007 whereas conditioned pain modulation predicted morphine consumption (β = -0.005, P = 0.001.Preoperative conditioned pain modulation and situational pain catastrophizing were not associated with the development of persistent postoperative pain following funnel chest repair. Secondary outcome analyses indicated that conditioned pain modulation predicted morphine consumption and situational pain catastrophizing predicted movement-evoked pain intensity in the acute postoperative phase. These findings may have

[The pain-emotion: Advocating pain as an emotion].

Science.gov (United States)

Fonseca Das Neves, J; Sule, N; Serra, E

2017-12-01

Pain is a common experience, both physical and emotional. However we often feel powerless with our patients suffering pain. This paper aims to give a new heuristic and psychological understanding of pain. According to new theories, recent researches as well as different points of view, we form an analogy between pain and emotion. Throughout historical considerations pain has always been perceived through theories and beliefs, changing its definition. This is also the case for emotion. Could they be two ways of expressing a single phenomenon? First, we must clarify the definition of emotion. In past, emotion was considered as a multiple-conditioned notion. To be considered as an emotion the pain had to fill numerous features, which differ according to the scientific opinions. The emotion may be considered as a physical expression or perceived only as the consequences of a real emotion, i.e., the subjective feeling. We propose as a way of thinking that emotion brings together these two concepts. We support a flexible vision of emotion. To investigate the field of the emotion different mental steps may be thought of: we should conceive of the emotion as a stimulus, as an emotional evaluation and as a tendency to action, which becomes an emotional response. These steps are colored by subjective feelings. It can be summarized in three levels: the situation decoding (1), the response organization (2) and the effectiveness of the response (3). Second pain can be considered as a complex notion involving personal and subjective feelings. We can use multidimensional patterns and consider emotion with its multiple features: the generating mechanisms, the pain perception, the pain behavior and the environment. Each stage can be divided in different ways. Hence pain treatment could be approached as an emotional treatment. Indeed, we can make a link between generating mechanisms and emotion situation decoding, between pain perception and emotion situation decoding and response

Are Pain-Related Fears Mediators for Reducing Disability and Pain in Patients with Complex Regional Pain Syndrome Type 1? An Explorative Analysis on Pain Exposure Physical Therapy

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Barnhoorn, Karlijn J.; Staal, J. Bart; van Dongen, Robert T. M.; Frölke, Jan Paul M.; Klomp, Frank P.; van de Meent, Henk; Samwel, Han; Nijhuis-van der Sanden, Maria W. G.

2015-01-01

Objective To investigate whether pain-related fears are mediators for reducing disability and pain in patients with Complex Regional Pain Syndrome type 1 when treating with Pain Exposure Physical Therapy. Design An explorative secondary analysis of a randomised controlled trial. Participants Fifty-six patients with Complex Regional Pain Syndrome type 1. Interventions The experimental group received Pain Exposure Physical Therapy in a maximum of five treatment sessions; the control group received conventional treatment following the Dutch multidisciplinary guideline. Outcome measures Levels of disability, pain, and pain-related fears (fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were measured at baseline and after 3, 6, and 9 months follow-up. Results The experimental group had a significantly larger decrease in disability of 7.77 points (95% CI 1.09 to 14.45) and in pain of 1.83 points (95% CI 0.44 to 3.23) over nine months than the control group. The potential mediators pain-related fears decreased significantly in both groups, but there were no significant differences between groups, which indicated that there was no mediation. Conclusion The reduction of pain-related fears was comparable in both groups. We found no indication that pain-related fears mediate the larger reduction of disability and pain in patients with Complex Regional Pain Syndrome type 1 treated with Pain Exposure Physical Therapy compared to conventional treatment. Trial registration International Clinical Trials Registry NCT00817128 PMID:25919011

Implicit associations between pain and self-schema in patients with chronic pain.

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Van Ryckeghem, Dimitri M L; De Houwer, Jan; Van Bockstaele, Bram; Van Damme, Stefaan; De Schryver, Maarten; Crombez, Geert

2013-12-01

Chronic pain often interferes with daily functioning, and may become a threat to an individual's sense of self. Despite the development of a recent theoretical account focussing upon the relationship between the presence of chronic pain and a person's self, research investigating this idea is limited. In the present study we aimed to (1) compare the strength of association between self- and pain schema in patients with chronic pain and healthy control subjects and (2) research whether the strength of association between self- and pain-schema is related to particular pain-related outcomes and individual differences of patients with chronic pain. Seventy-three patients with chronic pain (M(age) = 49.95; SD = 9.76) and 53 healthy volunteers (M(age) = 48.53; SD = 10.37) performed an Implicit Association Test (IAT) to assess the strength of association between pain- and self-schema. Patients with chronic pain also filled out self-report measures of pain severity, pain suffering, disability, depression, anxiety, acceptance, and helplessness. Results indicated that the pain- and self-schema were more strongly associated in patients with chronic pain than in healthy control subjects. Second, results indicated that, in patients with chronic pain, a stronger association between self- and pain-schema, as measured with the IAT, is related to a heightened level of pain severity, pain suffering, anxiety, and helplessness. Current findings give first support for the use of an IAT to investigate the strength of association between self- and pain-schema in patients with chronic pain and suggest that pain therapies may incorporate techniques that intervene on the level of self-pain enmeshment. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Prediction of pain in orthodontic patients based on preoperative pain assessment

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Zheng, Baoyu; Ren, Manman; Lin, Feiou; Yao, Linjie

2016-01-01

Aim To investigate whether pretreatment assessment of experimental pain can predict the level of pain after archwire placement. Methods One hundred and twenty-one general university students seeking orthodontic treatment were enrolled in this study. A cold pressor test was performed to estimate the pain tolerance of subjects before treatment. Self-reported pain intensity was calculated using a 10 cm visual analog scale during the 7 days after treatment. The relationship between pain tolerance and orthodontic pain was analyzed using Spearman’s correlation analysis. Results The maximum mean level of pain intensity occurred at 24 hours after bonding (53.31±16.13) and fell to normal levels at day 7. Spearman’s correlation analysis found a moderate positive association between preoperative pain tolerance and self-reported pain after archwire placement (P0.05). Conclusion A simple and noninvasive preoperative sensory test (the cold pressor test) was useful in predicting the risk of developing unbearable pain in patients after archwire placement. Self-reported pain after archwire placement decreased as individual pain tolerance increased. PMID:27042019

Translational pain research: evaluating analgesic effect in experimental visceral pain models

DEFF Research Database (Denmark)

Olesen, Anne Estrup; Andresen, Trine; Christrup, Lona Louring

2009-01-01

Deep visceral pain is frequent and presents major challenges in pain management, since its pathophysiology is still poorly understood. One way to optimize treatment of visceral pain is to improve knowledge of the mechanisms behind the pain and the mode of action of analgesic substances. This can ...... studies and clinical condition in patients suffering from visceral pain, and thus constitute the missing link in translational pain research.......Deep visceral pain is frequent and presents major challenges in pain management, since its pathophysiology is still poorly understood. One way to optimize treatment of visceral pain is to improve knowledge of the mechanisms behind the pain and the mode of action of analgesic substances. This can...... facilitate minimizing the gap between knowledge gained in animal and human clinical studies. Combining experimental pain studies and pharmacokinetic studies can improve understanding of the pharmacokinetic-pharmacodynamic relationship of analgesics and, thus, provide valuable insight into optimal clinical...

First Dutch Consensus of Pain Quality Indicators for Pain Treatment Facilities.

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de Meij, Nelleke; van Grotel, Marloes; Patijn, Jacob; van der Weijden, Trudy; van Kleef, Maarten

2016-01-01

There is a general consensus about the need to define and improve the quality of pain treatment facilities. Although guidelines and recommendations to improve the quality of pain practice management have been launched, provision of appropriate pain treatment is inconsistent and the quality of facilities varies widely. The aim of the study was to develop an expert-agreed list of quality indicators applicable to pain treatment facilities. The list was also intended to be used as the basis for a set of criteria for registered status of pain treatment facilities. The University Pain Center Maastricht at the Department of Anesthesiology and Pain Management of the Maastricht University Medical Center conducted a 3-round Delphi study in collaboration with the Board of the Pain Section of the Dutch Society of Anesthesiologists (NVA). Twenty-five quality indicators were selected as relevant to 2 types of pain treatment facilities, pain clinics and pain centers. The final expert-agreed list consisted of 22 quality indicators covering 7 quality domains: supervision, availability of care, staffing level and patient load, quality policy, multidisciplinarity, regionalization, and research and education. This set of quality indicators may facilitate organizational evaluation and improve insight into service quality from the perspectives of patients, pain specialists, and other healthcare professionals. Recommendations for improvements to the current set of quality indicators are made. In 2014 the process of registering pain treatment facilities in the Netherlands started; facilities can register as a pain clinic or pain center. © 2015 World Institute of Pain.

Differences in Pain Processing Between Patients with Chronic Low Back Pain, Recurrent Low Back Pain, and Fibromyalgia.

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Goubert, Dorien; Danneels, Lieven; Graven-Nielsen, Thomas; Descheemaeker, Filip; Meeus, Mira

2017-05-01

The impairment in musculoskeletal structures in patients with low back pain (LBP) is often disproportionate to their complaint. Therefore, the need arises for exploration of alternative mechanisms contributing to the origin and maintenance of non-specific LBP. The recent focus has been on central nervous system phenomena in LBP and the pathophysiological mechanisms underlying the various symptoms and characteristics of chronic pain. Knowledge concerning changes in pain processing in LBP remains ambiguous, partly due to the diversity in the LBP population. The purpose of this study is to compare quantitative sensory assessment in different groups of LBP patients with regard to chronicity. Recurrent low back pain (RLBP), mild chronic low back pain (CLBP), and severe CLBP are compared on the one hand with healthy controls (HC), and on the other hand with fibromyalgia (FM) patients, in which abnormal pain processing has previously been reported. Cross-sectional study. Department of Rehabilitation Sciences, Ghent University, Belgium. Twenty-three RLBP, 15 mild CLBP, 16 severe CLBP, 26 FM, and 21 HC participated in this study. Quantitative sensory testing was conducted by manual pressure algometry and computer-controlled cuff algometry. A manual algometer was used to evaluate hyperalgesia as well as temporal summation of pain and a cuff algometer was used to evaluate deep tissue hyperalgesia, the efficacy of the conditioned pain modulation and spatial summation of pain. Pressure pain thresholds by manual algometry were significantly lower in FM compared to HC, RLBP, and severe CLBP. Temporal summation of pain was significantly higher in FM compared to HC and RLBP. Pain tolerance thresholds assessed by cuff algometry were significantly lower in FM compared to HC and RLBP and also in severe CLBP compared to RLBP. No significant differences between groups were found for spatial summation or conditioned pain modulation. No psychosocial issues were taken into account for this

The differences of brain cortical activation between superficial pain and deep pain

International Nuclear Information System (INIS)

Ikemoto, Tatsunori; Ushida, Takahiro; Taniguchi, Shinichirou; Tani, Toshikazu; Morio, Kazuo; Sasaki, Toshikazu; Tanaka, Shigeki

2006-01-01

Using functional magnetic resonance imaging (FMRI) technology, we investigated the difference of pain related brain cortical activation derived from noxious stimulation to the skin and muscular tissue. Ten healthy volunteers who have no history of brain vascular disease were enrolled in this study. A cutaneous pain was provoked by isotonic (0.9%) saline injection into intra-dermal space on right lower leg through 24G plastic catheter, and a muscle pain was provoked by hypertonic (3%) saline injection into right tibialis anterior muscle. We used event-related FMRI to measure brain activity during each injection. Visual analogue scale (VAS) was used to quantify pain intensity and unpleasantness, and pain quality was assessed with several verbal descriptions. Pain unpleasantness rating was higher in the muscle pain compared to the cutaneous pain, despite the same pain intensity rating. The cutaneous pain had more acute pain onset than the muscle pain. Pain duration after stimulation was short in the cutaneous pain, but long in the muscle pain. The extent of the painful region tended to be larger with the muscle pain, but there was no statistical significance. Evoked FMRI response from the cutaneous pain showed distinct brain activation in the inferior and superior parietal cortex (BA: Brodmann area 5/7/40), primary and secondary somatosensory cortex (S1 and S2), insula, supplementary motor area (SMA, BA6), posterior cingulate cortex and cerebellum. On the other hand, FMRI response from muscle pain showed distinct brain activation mainly in the contralateral insula. These results suggest that the parietal lobe including the S1 is the essential area for cognition of sharp and well-localized pain conditions such as cutaneous pain, and may not be essential for cognition of diffuse pain derived from muscular tissue. (author)

Characterizing the Pain Narratives of Parents of Youth with Chronic Pain

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Noel, Melanie; Beals-Erickson, Sarah E.; Law, Emily F.; Alberts, Nicole; Palermo, Tonya M.

2015-01-01

Objectives Questionnaire-based research has shown that parents exert a powerful influence on and are profoundly influenced by living with a child with chronic pain. Examination of parents' pain narratives through an observational lens offers an alternative approach to understanding the complexity of pediatric chronic pain; however, the narratives of parents of youth with chronic pain have been largely overlooked. The present study aimed to characterize the vulnerability- and resilience-based aspects of the pain narratives of parents of youth with chronic pain. Methods Pain narratives of 46 parents were recorded during the baseline session as part of two clinical trials evaluating a behavioral intervention for parents of youth with chronic pain. The narratives were coded for aspects of pain-related vulnerability and resilience. Results Using exploratory cluster analysis, two styles of parents’ pain narratives were identified. Distress narratives were characterized by more negative affect and an exclusively unresolved orientation towards the child’s diagnosis of chronic pain whereas resilience narratives were characterized by positive affect and a predominantly resolved orientation towards the child’s diagnosis. Preliminary support for the validity of these clusters was provided through our finding of differences between clusters in parental pain catastrophizing about child pain (helplessness). Discussion Findings highlight the multidimensional nature of parents’ experience of their child’s pain problem. Clinical implications in terms of assessment and treatment are discussed. PMID:26736026

Making Sense of Low Back Pain and Pain-Related Fear.

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Bunzli, Samantha; Smith, Anne; Schütze, Robert; Lin, Ivan; O'Sullivan, Peter

2017-09-01

Synopsis Pain-related fear is implicated in the transition from acute to chronic low back pain and the persistence of disabling low back pain, making it a key target for physical therapy intervention. The current understanding of pain-related fear is that it is a psychopathological problem, whereby people who catastrophize about the meaning of pain become trapped in a vicious cycle of avoidance behavior, pain, and disability, as recognized in the fear-avoidance model. However, there is evidence that pain-related fear can also be seen as a common-sense response to deal with low back pain, for example, when one is told that one's back is vulnerable, degenerating, or damaged. In this instance, avoidance is a common-sense response to protect a "damaged" back. While the fear-avoidance model proposes that when someone first develops low back pain, the confrontation of normal activity in the absence of catastrophizing leads to recovery, the pathway to recovery for individuals trapped in the fear-avoidance cycle is less clear. Understanding pain-related fear from a common-sense perspective enables physical therapists to offer individuals with low back pain and high fear a pathway to recovery by altering how they make sense of their pain. Drawing on a body of published work exploring the lived experience of pain-related fear in people with low back pain, this clinical commentary illustrates how Leventhal's common-sense model may assist physical therapists to understand the broader sense-making processes involved in the fear-avoidance cycle, and how they can be altered to facilitate fear reduction by applying strategies established in the behavioral medicine literature. J Orthop Sports Phys Ther 2017;47(9):628-636. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7434.

Pronociceptive pain modulation in patients with painful chemotherapy-induced polyneuropathy.

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Nahman-Averbuch, Hadas; Yarnitsky, David; Granovsky, Yelena; Sprecher, Elliot; Steiner, Mariana; Tzuk-Shina, Tzahala; Pud, Dorit

2011-08-01

Several chemotherapy agents induce polyneuropathy that is painful for some patients, but not for others. We assumed that these differences might be attributable to varying patterns of pain modulation. The aim of the present study was to evaluate pain modulation in such patients. Twenty-seven patients with chemotherapy-induced polyneuropathy were tested for detection thresholds (cold, warm, and mechanical) in both the forearm and foot, as well as for heat pain threshold, mechanical temporal summation (TS), and conditioned pain modulation (CPM; also known as the diffuse noxious inhibitory control-like effect), which were tested in the upper limbs. Positive correlations were found between clinical pain levels and both TS (r=0.52, P=0.005) and CPM (r=0.40, P=0.050) for all patients. In addition, higher TS was associated with less efficient CPM (r=0.56, P=0.004). The group of patients with painful polyneuropathy (n=12) showed a significantly higher warm detection threshold in the foot (P=0.03), higher TS (P<0.01), and less efficient CPM (P=0.03) in comparison to the group with nonpainful polyneuropathy. The painfulness of polyneuropathy is associated with a "pronociceptive" modulation pattern, which may be primary to the development of pain. The higher warm sensory thresholds in the painful polyneuropathy group suggest that the severity of polyneuropathy may be another factor in determining its painfulness. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Chronic abdominal wall pain misdiagnosed as functional abdominal pain.

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van Assen, Tijmen; de Jager-Kievit, Jenneke W A J; Scheltinga, Marc R; Roumen, Rudi M H

2013-01-01

The abdominal wall is often neglected as a cause of chronic abdominal pain. The aim of this study was to identify chronic abdominal wall pain syndromes, such as anterior cutaneous nerve entrapment syndrome (ACNES), in a patient population diagnosed with functional abdominal pain, including irritable bowel syndrome, using a validated 18-item questionnaire as an identification tool. In this cross-sectional analysis, 4 Dutch primary care practices employing physicians who were unaware of the existence of ACNES were selected. A total of 535 patients ≥18 years old who were registered with a functional abdominal pain diagnosis were approached when they were symptomatic to complete the questionnaire (maximum 18 points). Responders who scored at least the 10-point cutoff value (sensitivity, 0.94; specificity, 0.92) underwent a diagnostic evaluation to establish their final diagnosis. The main outcome was the presence and prevalence of ACNES in a group of symptomatic patients diagnosed with functional abdominal pain. Of 535 patients, 304 (57%) responded; 167 subjects (31%) recently reporting symptoms completed the questionnaire. Of 23 patients who scored above the 10-point cutoff value, 18 were available for a diagnostic evaluation. In half of these subjects (n = 9) functional abdominal pain (including IBS) was confirmed. However, the other 9 patients were suffering from abdominal wall pain syndrome, 6 of whom were diagnosed with ACNES (3.6% prevalence rate of symptomatic subjects; 95% confidence interval, 1.7-7.6), whereas the remaining 3 harbored a painful lipoma, an abdominal herniation, and a painful scar. A clinically relevant portion of patients previously diagnosed with functional abdominal pain syndrome in a primary care environment suffers from an abdominal wall pain syndrome such as ACNES.

Pain and Nociception

DEFF Research Database (Denmark)

Falk, Sarah; Dickenson, Anthony H

2014-01-01

Cancer pain, especially pain caused by metastasis to bone, is a severe type of pain, and unless the cause and consequences can be resolved, the pain will become chronic. As detection and survival among patients with cancer have improved, pain has become an increasing challenge, because traditiona...

Narrative reconstruction therapy for prolonged grief disorder—rationale and case study

Directory of Open Access Journals (Sweden)

Tuvia Peri

2016-05-01

Full Text Available Background: Prolonged grief disorder (PGD is a potentially disabling condition affecting approximately 10% of bereaved people. It has been suggested that the impaired integration of the loss memory, as expressed in recurrent memories of the loss and disorganization of memory, is involved in the development of PGD. Narrative reconstruction (NR, originally designed for the treatment of posttraumatic stress disorder (PTSD in an integrative therapy module, and consisting of exposure to the loss memory, detailed written reconstruction of the loss memory narrative and an elaboration of the personal significance of that memory for the bereaved, has been shown to be effective in the treatment of intrusion symptoms. Objective: In light of findings that cognitive behavior therapy (CBT, including cognitive restructuring and exposure, is effective in the treatment of PGD, we suggest the implementation of a somewhat novel therapy module, NR, for the treatment of intrusive phenomena in bereaved patients. Method: The rationale for the implementation of NR for PGD and a case study of the treatment of a woman suffering from PGD after the death of her father are presented. Therapy took place in a university outpatient training clinic. Results: Evaluations conducted before and after treatment and at a 3-month follow-up demonstrated the effectiveness of NR in reducing symptoms of PGD and depression. The analysis of spontaneous narratives recorded before and after treatment showed an increased organization of the narratives. Conclusions: This case report demonstrates an adaptation of NR for the treatment of PGD. The results provide preliminary support for the effectiveness of NR for PGD. The significance of the study and its limitations are discussed.

Chronic Widespread Back Pain is Distinct From Chronic Local Back Pain: Evidence From Quantitative Sensory Testing, Pain Drawings, and Psychometrics.

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Gerhardt, Andreas; Eich, Wolfgang; Janke, Susanne; Leisner, Sabine; Treede, Rolf-Detlef; Tesarz, Jonas

2016-07-01

Whether chronic localized pain (CLP) and chronic widespread pain (CWP) have different mechanisms or to what extent they overlap in their pathophysiology is controversial. The study compared quantitative sensory testing profiles of nonspecific chronic back pain patients with CLP (n=48) and CWP (n=29) with and fibromyalgia syndrome (FMS) patients (n=90) and pain-free controls (n = 40). The quantitative sensory testing protocol of the "German-Research-Network-on-Neuropathic-Pain" was used to measure evoked pain on the painful area in the lower back and the pain-free hand (thermal and mechanical detection and pain thresholds, vibration threshold, pain sensitivity to sharp and blunt mechanical stimuli). Ongoing pain and psychometrics were captured with pain drawings and questionnaires. CLP patients did not differ from pain-free controls, except for lower pressure pain threshold (PPT) on the back. CWP and FMS patients showed lower heat pain threshold and higher wind-up ratio on the back and lower heat pain threshold and cold pain threshold on the hand. FMS showed lower PPT on back and hand, and higher comorbidity of anxiety and depression and more functional impairment than all other groups. Even after long duration CLP presents with a local hypersensitivity for PPT, suggesting a somatotopically specific sensitization of nociceptive processing. However, CWP patients show widespread ongoing pain and hyperalgesia for different stimuli that is generalized in space, suggesting the involvement of descending control systems, as also suggested for FMS patients. Because mechanisms in nonspecific chronic back pain with CLP and CWP differ, these patients should be distinguished in future research and allocated to different treatments.

Bone pain

DEFF Research Database (Denmark)

Frost, Charlotte Ørsted; Hansen, Rikke Rie; Heegaard, Anne-Marie

2016-01-01

Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology...... of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease...... modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent preclinical findings demonstrating a unique neuronal innervation of bone tissue and sprouting of sensory nerve fibers open for new treatment possibilities....

Pain patterns and descriptions in patients with radicular pain: Does the pain necessarily follow a specific dermatome?

Directory of Open Access Journals (Sweden)

Hurwitz Eric L

2009-09-01

Full Text Available Abstract Background It is commonly stated that nerve root pain should be expected to follow a specific dermatome and that this information is useful to make the diagnosis of radiculopathy. There is little evidence in the literature that confirms or denies this statement. The purpose of this study is to describe and discuss the diagnostic utility of the distribution of pain in patients with cervical and lumbar radicular pain. Methods Pain drawings and descriptions were assessed in consecutive patients diagnosed with cervical or lumbar nerve root pain. These findings were compared with accepted dermatome maps to determine whether they tended to follow along the involved nerve root's dermatome. Results Two hundred twenty-six nerve roots in 169 patients were assessed. Overall, pain related to cervical nerve roots was non-dermatomal in over two-thirds (69.7% of cases. In the lumbar spine, the pain was non-dermatomal in just under two-thirds (64.1% of cases. The majority of nerve root levels involved non-dermatomal pain patterns except C4 (60.0% dermatomal and S1 (64.9% dermatomal. The sensitivity (SE and specificity (SP for dermatomal pattern of pain are low for all nerve root levels with the exception of the C4 level (Se 0.60, Sp 0.72 and S1 level (Se 0.65, Sp 0.80, although in the case of the C4 level, the number of subjects was small (n = 5. Conclusion In most cases nerve root pain should not be expected to follow along a specific dermatome, and a dermatomal distribution of pain is not a useful historical factor in the diagnosis of radicular pain. The possible exception to this is the S1 nerve root, in which the pain does commonly follow the S1 dermatome.

Atypical electrophysiological activity during pain observation in amputees who experience synaesthetic pain.

Science.gov (United States)

Fitzgibbon, Bernadette M; Enticott, Peter G; Giummarra, Melita J; Thomson, Richard H; Georgiou-Karistianis, Nellie; Bradshaw, John L

2012-03-01

There are increasing reports of people experiencing pain when observing pain in another. This describes the phenomenon of synaesthetic pain which, until recently, had been primarily reported in amputees with phantom pain. In the current study, we used electroencephalography (EEG) to investigate how amputees who experience synaesthetic pain process pain observed in another. Participants were grouped according to amputees who experience phantom and synaesthetic pain (n=8), amputees who experience phantom pain but not synaesthetic pain (n=10) and healthy controls (n=10). Participants underwent EEG as they observed still images of hands and feet in potentially painful and non-painful situations. We found that pain synaesthetes showed some reduced event-related potential (ERP) components at certain electrode sites, and reduced theta- and alpha band power amplitude at a central electrode. The finding of reduced ERP amplitude and theta band power may reflect inhibition of the processing of observed pain (e.g. avoidance/guarding as a protective strategy), and reduced alpha band power may indicate a disinhibition in control processes that may result in synaesthetic pain. These results provide the first documentation of atypical neurophysiological activity in amputees who experience synaesthetic pain when processing pain in another. © The Author (2011). Published by Oxford University Press.

Fear of pain in children and adolescents with neuropathic pain and CRPS

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Simons, Laura E.

2015-01-01

A significant proportion of children and adolescents with chronic pain endorse elevated pain-related fear. Pain-related fear is associated with high levels of disability, depressive symptoms, and school impairment. Due to faulty nerve signaling, individuals with neuropathic pain and CRPS may be more prone to develop pain-related fear as they avoid use of and neglect the affected body area(s), resulting in exacerbated symptoms, muscle atrophy, maintenance of pain signaling, and ongoing pain-related disability. Not surprisingly, effective treatments for elevated pain-related fears involve exposure to previously avoided activities to down-regulate incorrect pain signaling. In the context of intensive interdisciplinary pain treatment of youth with neuropathic pain, decreasing pain-related fear is associated with improved physical and psychological functioning, while high initial pain-related fear is a risk factor for less treatment responsiveness. An innovative approach to targeting pain-related fear as well as evidence of a neural response to treatment involving decoupling of the amygdala with key fear circuits in youth with CRPS suggest breakthroughs in our ability to ameliorate these issues. PMID:26785161

Future Directions for Pain Management: Lessons from the Institute of Medicine Pain Report and the National Pain Strategy.

Science.gov (United States)

Mackey, Sean

2016-02-01

According to the Institute of Medicine Relieving Pain in America Report and the soon to be released National Pain Strategy, pain affects over 100 million Americans and costs our country in over $500 billion per year. We have a greater appreciation for the complex nature of pain and that it can develop into a disease in itself. As such, we need more efforts on prevention of chronic pain and for interdisciplinary approaches. For precision pain medicine to be successful, we need to link learning health systems with pain biomarkers (eg, genomics, proteomics, patient reported outcomes, brain markers) and its treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Review: Psychogenic Aspect of Pain & Coceptualization of Psychogenic Pain in Children

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Ali Reza Jazayeri

2004-06-01

Full Text Available Pain is the sensory and emotional experience of discomfort whiehis usually associated with actual or threatened physical damsge or irritation . Virtvally all people experience pain at all ages. Children also experience pain from the moment of birth through childhood years. Underestaning pain in children is very important , because of treatment implication and its influence in child physical and psychological development . Experienced researchers have found that pain is a concequence of emotional disorder which is observed in some patients . in many cases we have seen that a patient says to his / her clinician that she has no pain because there is no evidence of somatic disease. Dicomfont involved in psychogenic pain seems to resort primerly from psychological process. Many of physicion are familiar with unpleasant and avoidant concequences of these distortions . In these cases , it s better for us to agree with patients , experience of pain and not to prob somatic risk factors and their mechanism all the time. The researches hove recognized that psychological factors cam cause pain which is named psychogenic pain. It means that the cause of pain has psychological roots , versus organic pain which is related to discomfort is caused by tissue damage . In this study , theorical , psychological , psychoanalytical and psycho social approaches and personality characteristics description related to pain and the relations among these approaches in this area have been studied . Also, the perception of pain among children with different gender have been probed

Understanding cultural influences on back pain and back pain research.

Science.gov (United States)

Henschke, Nicholas; Lorenz, Eva; Pokora, Roman; Michaleff, Zoe A; Quartey, Jonathan N A; Oliveira, Vinicius Cunha

2016-12-01

Low back pain is highly prevalent and places a considerable burden on individuals, their families and communities. This back pain burden is unequally distributed around the world and within populations. Clinicians and researchers addressing back pain should be aware of the cultural, social and political context of back pain patients and how this context can influence pain perception, disability and health care use. Culture, which influences the beliefs and behaviour of individuals within a social group, could be considered an important contributor to the unequal distribution of back pain. However, there is paucity of high-quality research exploring the influence of culture on the experience and management of back pain. Further development and testing of specific tools, assessment methods and communication strategies are needed to improve our understanding of how cultural practices, values and identifications affect those dealing with back pain. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evaluation of pain management interventions for neonatal circumcision pain.

Science.gov (United States)

Joyce, B A; Keck, J F; Gerkensmeyer, J

2001-01-01

The purpose of the study was to determine the efficacy of music and eutectic mixture of local anesthetics (EMLA) on pain responses of neonates undergoing circumcision. A randomized, double-blind experimental design was used with 23 neonates. Pain response was measured using an observational pain intensity rating scale and the physiologic parameters of heart rate, respiratory rate, oxygen saturation levels, salivary cortisol levels, and length of cry. Each infant's state was examined for a potential contribution to the pain response. Infant state, salivary cortisol levels, and respiratory rates were not significant. Pain ratings had considerable variability for all treatment conditions, but both single treatment groups had less pain by the end of the procedure. The heart rate was significantly lower for the EMLA group and remained stable for the music group. Oxygen saturation differences were statistically significant for the music group (P =.02) and approached significance for the EMLA group. Preliminary support was provided for the efficacy of EMLA and music to contribute to the pain relief of neonates undergoing circumcision. Further study is warranted. Neonates deserve interventions that will provide them with a less painful start in life.

Pain modulatory phenotypes differentiate subgroups with different clinical and experimental pain sensitivity

DEFF Research Database (Denmark)

Vaegter, Henrik B.; Graven-Nielsen, Thomas

2016-01-01

between subgroups. Cuff algometry was performed on lower legs in 400 chronic pain patients to assess pressure pain threshold (cPPT), pressure pain tolerance (cPTT), temporal summation of pain (TSP: increase in pain scores to ten repeated stimulations), and conditioned pain modulation (CPM: increase in c......PPT during cuff pain conditioning on the contralateral leg). Heat detection (HDT) and heat pain thresholds (HPT) at clinical painful and non-painful body areas were assessed. Based on TSP and CPM four distinct groups were formed: Group 1 (n=85) had impaired CPM and facilitated TSP. Group 2 (n=148) had...... impaired CPM and normal TSP. Group 3 (n=45) had normal CPM and facilitated TSP. Group 4 (n=122) had normal CPM and normal TSP. Group 1 showed more pain regions compared with the other three groups (PCPM and facilitated TSP plays an important role in widespread pain. Group 1...

Vicarious pain experiences while observing another in pain: an experimental approach

Directory of Open Access Journals (Sweden)

Sophie eVandenbroucke

2013-06-01

Full Text Available Objective: This study aimed at developing an experimental paradigm to assess vicarious pain experiences. We further explored the putative moderating role of observer’s characteristics such as hypervigilance for pain and dispositional empathy. Methods: Two experiments are reported using a similar procedure. Undergraduate students were selected based upon whether they reported vicarious pain in daily life, and categorized into a pain responder group or a comparison group. Participants were presented a series of videos showing hands being pricked whilst receiving occasionally pricking (electrocutaneous stimuli themselves. In congruent trials, pricking and visual stimuli were applied to the same spatial location. In incongruent trials, pricking and visual stimuli were in the opposite spatial location. Participants were required to report on which location they felt a pricking sensation. Of primary interest was the effect of viewing another in pain upon vicarious pain errors, i.e., the number of trials in which an illusionary sensation was reported. Furthermore, we explored the effect of individual differences in hypervigilance to pain, dispositional empathy and the rubber hand illusion (RHI upon vicarious pain errors. Results: Results of both experiments indicated that the number of vicarious pain errors was overall low. In line with expectations, the number of vicarious pain errors was higher in the pain responder group than in the comparison group. Self-reported hypervigilance for pain lowered the probability of reporting vicarious pain errors in the pain responder group, but dispositional empathy and the RHI did not. Conclusion: Our paradigm allows measuring vicarious pain experiences in students. However, the prevalence of vicarious experiences of pain is low, and only a small percentage of participants display the phenomenon. It remains however unknown which variables affect its occurrence.

Low back pain - acute

Science.gov (United States)

Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back strain - new ... lower back supports most of your body's weight. Low back pain is the number two reason that Americans see ...

Modeling subjective well-being in individuals with chronic pain and a physical disability: the role of pain control and pain catastrophizing.

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Furrer, Angela; Michel, Gisela; Terrill, Alexandra L; Jensen, Mark P; Müller, Rachel

2017-10-23

To investigate the associations between subjective well-being and pain intensity, pain interference, and depression in individuals with physical disabilities. We hypothesized that (1) pain control and (2) pain catastrophizing mediate the effects of subjective well-being on pain intensity, pain interference, and depression. Analyses of cross-sectional data from 96 individuals diagnosed with spinal cord injury, multiple sclerosis, neuromuscular disease, or post-polio syndrome, with average pain intensity of ≥4 (0-10) on at least half the days in the past month. Two models tested study hypotheses using structural equation. Both models showed acceptable model fit. Pain catastrophizing significantly mediated the effect of subjective well-being on pain intensity and pain interference, but not on depression. Pain control did not significantly mediate the effect of subjective well-being on pain intensity, pain interference, or depression. Path coefficients showed significant direct effects of subjective well-being on pain control (β = 0.39), pain catastrophizing (β = -0.61), pain interference (β = -0.48; -0.42), and depression (β = -0.75; -0.78). This study supports the potential of enhancing subjective well-being and lowering pain catastrophizing for reducing pain intensity, pain interference, and depressive symptoms in individuals with chronic pain and a physical disability. The findings indicate that true experiments to test for causal associations are warranted. Implications for rehabilitation The majority of individuals with physical disabilities report having persistent moderate-to-severe pain that may negatively limit daily activities and quality of life. The present cross-sectional study indicates that individuals who reported greater subjective well-being showed significantly lower pain intensity via the mediating effect of lower pain catastrophizing. Since sample size and respective power are low, these findings should be taken as first

Pain and pharmacologic pain management in long-stay nursing home residents.

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Hunnicutt, Jacob N; Ulbricht, Christine M; Tjia, Jennifer; Lapane, Kate L

2017-06-01

Previous studies estimate that >40% of long-stay nursing home (NH) residents experience persistent pain, with 20% of residents in pain receiving no analgesics. Strengthened NH surveyor guidance and improved pain measures on the Minimum Data Set 3.0 were introduced in March 2009 and October 2010, respectively. This study aimed to provide estimates after the important initiatives of (1) prevalence and correlates of persistent pain; and (2) prevalence and correlates of untreated or undertreated persistent pain. We identified 1,387,405 long-stay residents in U.S. NHs between 2011 and 2012 with 2 Minimum Data Set assessments 90 days apart. Pain was categorized as persistent (pain on both assessments), intermittent (pain on either assessment), or none. Pharmacologic pain management was classified as untreated pain (no scheduled or as needed medications received) or potentially undertreated (no scheduled received). Modified Poisson models adjusting for resident clustering within NHs provided adjusted prevalence ratios (APRs) estimates and 95% confidence intervals (CIs). The prevalence of persistent and intermittent pain was 19.5% and 19.2%, respectively, but varied substantially by age, sex, race and ethnicity, cognitive impairment, and cancer. Of residents in persistent pain, 6.4% and 32.0% were untreated and undertreated, respectively. Racial and ethnic minorities (non-Hispanic blacks vs whites, APR = 1.19, 95% CI: 1.13-1.25) and severely cognitively impaired residents (severe vs no/mild APR = 1.51, 95% CI: 1.44-1.57) had an increased prevalence of untreated and undertreated pain. One in 5 NH residents has persistent pain. Although this estimate is greatly improved, many residents may be undertreated. The disturbing disparities in untreated and undertreated pain need to be addressed.

Managing painful chronic wounds: the Wound Pain Management Model

DEFF Research Database (Denmark)

Price, Patricia; Fogh, Karsten; Glynn, Chris

2007-01-01

of the pain experience: location, duration, intensity, quality, onset and impact on activities of daily living. Holistic management must be based on a safe and effective mix of psychosocial approaches together with local and systemic pain management. It is no longer acceptable to ignore or inadequately...... to the wound should be handled as one of the main priorities in chronic wound management together with addressing the cause. Management of pain in chronic wounds depends on proper assessment, reporting and documenting patient experiences of pain. Assessment should be based on six critical dimensions...... document persistent wound pain and not to develop a treatment and monitoring strategy to improve the lives of persons with chronic wounds. Unless wound pain is optimally managed, patient suffering and costs to health care systems will increase. Udgivelsesdato: 2007-Apr...

Doubling Your Payoff: Winning Pain Relief Engages Endogenous Pain Inhibition1,2,3

Science.gov (United States)

Kwan, Saskia; Schweinhardt, Petra

2015-01-01

Abstract When in pain, pain relief is much sought after, particularly for individuals with chronic pain. In analogy to augmentation of the hedonic experience (“liking”) of a reward by the motivation to obtain a reward (“wanting”), the seeking of pain relief in a motivated state might increase the experience of pain relief when obtained. We tested this hypothesis in a psychophysical experiment in healthy human subjects, by assessing potential pain-inhibitory effects of pain relief “won” in a wheel of fortune game compared with pain relief without winning, exploiting the fact that the mere chance of winning induces a motivated state. The results show pain-inhibitory effects of pain relief obtained by winning in behaviorally assessed pain perception and ratings of pain intensity. Further, the higher participants scored on the personality trait novelty seeking, the more pain inhibition was induced. These results provide evidence that pain relief, when obtained in a motivated state, engages endogenous pain-inhibitory systems beyond the pain reduction that underlies the relief in the first place. Consequently, such pain relief might be used to improve behavioral pain therapy, inducing a positive, perhaps self-amplifying feedback loop of reduced pain and improved functionality. PMID:26464995

Paediatric pain management

African Journals Online (AJOL)

patients is musculoskeletal pain, headache or abdominal pain.2. The pain ... Children older than four years of age can usually talk about their pain; at the age of six to eight years they can use the ... Pain presentation in children normally falls into one of the ... expression, body posture and movement.10 This scale is often.

[Pain therapy in pediatric oncology: pain experience, drugs and pharmacokinetics].

Science.gov (United States)

Mertens, Rolf

2011-11-01

Paediatric cancer patients often experience fear and pain from the disease but also in connection with the necessary diagnostic and therapeutic procedures. The treatment of pain is a priority for all patients, especially for critically ill children because of their vulnerability and limited understanding. The experience of pain is always subjective and depends on the age, the pain experience and the environment.In contrast to adults, it is often difficult to detect character of pain, pain intensity and pain localization in very young patients. Diagnostic and therapeutic procedures are performed in analgosedation for a given drug scheme by a pediatrician experienced in intensive care.In addition, a local anesthetic for an access system/lumbar punctures in the form of EMLA® patch is to be carried out. A rapid and effective treatment of pain and appropriate analgesia can prevent patients from being traumatized.For severe pain, malignancy- or chemotherapy-induced (eg. mucositis WHO grade 3 and 4) initial use of strong opiates is recommended instead of climbing the WHO ladder. For strong opiates, there is no maximum dose, as long as a dose increase leads to clinically observable increase in analgesia, without severe side effects. Patient-controlled analgesia with morphine as continuous subcutaneous or intravenous infusions and the possibility of a bolus injection is suited for children aged 6 years. A measurement of O2-saturation is essential during this infusion. Prophylactic approaches also must be used consistently in regard to the acute side effect of opiate treatment. Good experience, we have also made a non-drug therapy, e.g. personnel/physical affection, cuddling, massage, etc.The choice of analgesia depends on the nature and cause of pain. In neuropathic pain or phantom pain coanalgetics should be used to effectively treat pain in young patients. Different analgesic treatment approaches of the appropriate indications and adverse effects are presented. A

Pain begets pain: When marathon runners are not in pain anymore, they underestimate their memory of marathon pain: A mediation analysis

NARCIS (Netherlands)

Babel, P.; Bajcar, E.A.; Smieja, M.; Adamczyk, W.; Swider, K.J.; Kicman, P.; Lisinska, N.

2018-01-01

Background: A previous study has shown that memory of pain induced by running a marathon might be underestimated. However, little is known about the factors that might influence such a memory distortion during pain recall. The aim of the study was to investigate the memory of pain induced by running

The impact of experiential avoidance on the relations between illness representations, pain catastrophising and pain interference in chronic pain.

Science.gov (United States)

Karademas, Evangelos C; Karekla, Maria; Flouri, Magdalini; Vasiliou, Vasilis S; Kasinopoulos, Orestis; Papacostas, Savvas S

2017-12-01

The aim of this study was to examine the effects of experiential avoidance (EA) on the indirect relationship of chronic pain patients' illness representations to pain interference, through pain catastrophising Design and main outcome measure: The sample consisted of 162 patients diagnosed with an arthritis-related or a musculoskeletal disorder. The effects of EA on the pathway between illness representations, pain catastrophising and pain interference were examined with PROCESS, a computational tool for SPSS Results: After controlling for patient and illness-related variables and pain severity, the 'illness representations-pain catastrophising-pain interference' pathway was interrupted at the higher levels of EA. The reason was that, at the high levels of EA, either the relation of illness representations to pain catastrophising or the relation of pain catastrophising to pain interference was not statistically significant. The findings indicate that EA is not a generalised negative response to highly aversive conditions, at least as far as the factors examined in this study are concerned. EA may rather reflect a coping reaction, the impact of which depends on its specific interactions with the other aspects of the self-regulation mechanism. At least in chronic pain, EA should become the focus of potential intervention only when its interaction with the illness-related self-regulation mechanism results in negative outcomes.

Educational achievement and chronic pain disability: mediating role of pain-related cognitions.

Science.gov (United States)

Roth, Randy S; Geisser, Michael E

2002-01-01

This study examined the relation between level of educational achievement (LOE) and the clinical morbidity associated with chronic pain. a multidisciplinary pain rehabilitation program located within a university hospital. Two hundred ninety-nine consecutive patients with chronic spinal pain, average age 39.6 years (SD = 10.7) and with an average duration of pain of 41.9 months (SD = 51.6). Age, duration of pain, sex, and compensation and litigation status were controlled for in the statistical analysis because each was found to be significantly associated with LOE. Pain intensity was assessed by the McGill Pain Questionnaire. Affective distress was assessed by the Global Severity Index from the Brief Symptom Inventory. Severity of depressive symptoms was derived from scores from the Center for Epidemiological Studies-Depression Scale. Pain beliefs and pain coping strategies were assessed by the Survey of Pain Attitudes and the Coping Strategies Questionnaire, respectively. Finally, self-report of pain-related disability was assessed by the Pain Disability Index. After controlling for relevant covariates, LOE was unrelated to pain intensity, severity of depressive symptoms, or affective distress, but was inversely related to self-reported disability. Persons with lower LOEs possessed a greater belief that pain is a "signal of harm," unrelated to emotional experience, disabling and uncontrollable. They also endorsed more passive and maladaptive coping strategies, including a tendency to catastrophize about their pain. Path analysis indicated that, after controlling for the influence of both the belief that pain is a "signal of harm" and catastrophizing on the association between LOE and disability, this relation loses statistical significance. These results suggest that pain-related cognitions mediate the relation between LOE and pain disability and that persons with lower LOEs are more likely to develop maladaptive pain beliefs and coping strategies.

Pain Information Brochure

Science.gov (United States)

... Library Health Care Systems Research Collaboratory Pain Registries IOM Report: Relieving Pain in America HHS Pathways to ... Library Health Care Systems Research Collaboratory Pain Registries IOM Report: Relieving Pain in America HHS Pathways to ...

NIH Pain Consortium

Science.gov (United States)

... Library Health Care Systems Research Collaboratory Pain Registries IOM Report: Relieving Pain in America HHS Pathways to ... Library Health Care Systems Research Collaboratory Pain Registries IOM Report: Relieving Pain in America HHS Pathways to ...

Fear of pain in the context of intensive pain rehabilitation among children and adolescents with neuropathic pain: associations with treatment response.

Science.gov (United States)

Simons, Laura E; Kaczynski, Karen J; Conroy, Caitlin; Logan, Deirdre E

2012-12-01

Recent research has implicated pain-related fear in relation to functional outcomes in children with chronic pain. The current study examined fear of pain, disability, and depression within the context of an intensive pain rehabilitation program. One hundred forty-five children and adolescents who participated in an intensive interdisciplinary pediatric pain rehabilitation day program were assessed in this study. Patients completed measures of pain intensity, pain-related fears, functional disability, and depressive symptoms at admission, discharge, and on average, 2 months postdischarge. After controlling for pain intensity, pain-related fear was significantly related to disability and depressive symptoms at all time points. As predicted, a decline in pain-related fear was significantly associated with a decrease in disability and depressive symptoms. Interestingly, high levels of pain-related fears at admission predicted less reduction in functional disability and depression at discharge, suggesting that high levels of pain-related fear may be a risk factor in relation to treatment outcomes. Overall, results indicate that the relationship between fear of pain and changes in disability and depressive symptoms are closely linked, with fear of pain playing an important role in treatment. This paper presents results underscoring the importance of pain-related fear in relation to treatment response for children and adolescents with chronic pain. These findings support the need to develop and implement interventions that target reductions in pain-related fear. Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

Pain, emotion, headache.

Science.gov (United States)

Bussone, Gennaro; Grazzi, Licia; Panerai, Alberto E

2012-10-01

Pain has been considered as part of a defensive strategy whose specific role is to signal an immediate active danger to the organism. This definition fits well for acute pain. It does not work well, however, for chronic pain that is maintained even in absence of an ongoing, active threat. Currently, acute and chronic pain are considered to be separate conditions. What follows is a review of the different theories about pain and its history. Different hypotheses regarding pain mechanisms are illustrated. New data emerging from scientific research on chronic pain (migraine in particular) involving innovative imaging techniques are reported and discussed. © 2012 American Headache Society.

Exploring the associations shared by mood, pain-related attention and pain outcomes related to sleep disturbance in a chronic pain sample.

Science.gov (United States)

Harrison, Lee; Wilson, Sue; Heron, Jon; Stannard, Catherine; Munafò, Marcus R

2016-05-01

Sleep disturbance in chronic pain is common, occurring in two-thirds of patients. There is a complex relationship between chronic pain and sleep; pain can disrupt sleep and poor sleep can exaggerate pain intensity. This may have an impact on both depressive symptoms and attention to pain. This study aims to evaluate the relationship between chronic pain and sleep, and the role of mood and attention. Chronic pain patients, recruited from a secondary care outpatient clinic, completed self-report measures of pain, sleep, depressive symptoms and attention to pain. Hierarchical regression and structural equation modelling were used to explore the relationships between these measures. Participants (n = 221) were aged between 20 and 84 (mean = 52) years. The majority of participants were found to be 'poor sleepers' (86%) with increased pain severity, depressive symptoms and attention to pain. Both analytical approaches indicated that sleep disturbance is indirectly associated with increased pain severity Instead the relationship shared by sleep disturbance and pain severity was further associated with depressive symptoms and attention to pain. Our results indicate that sleep disturbance may contribute to clinical pain severity indirectly though changes in mood and attention. Prospective studies exploring lagged associations between these constructs could have critical information relevant to the treatment of chronic pain.

Evaluation of pain incidence and pain management in a South ...

African Journals Online (AJOL)

Design. A prospective observational study, using the Numerical Rating Scale for pain (NRS pain), Numerical Rating Scale for anxiety (NRS anxiety), the Alder Hey Triage Pain Score (AHTPS), the COMFORT behaviour scale and the Touch Visual Pain Scale (TVPS). All patients were assessed at admission; those who were ...

Happiness, Pain Intensity, Pain Interference, and Distress in Individuals with Physical Disabilities.

Science.gov (United States)

Müller, Rachel; Terrill, Alexandra L; Jensen, Mark P; Molton, Ivan R; Ravesloot, Craig; Ipsen, Catherine

2015-12-01

The aim of this study was to examine how the construct of happiness is related to pain intensity, pain interference, and distress in individuals with physical disabilities. This study involves cross-sectional analyses of 471 individuals with a variety of health conditions reporting at least mild pain. The first hypothesis that happiness mediates the relationship between pain intensity and two outcomes, pain interference and distress, was not supported. The second hypothesis was supported by a good fitting model (χ2(10) = 12.83, P = 0.23, root-mean-square error of approximation = 0.025) and indicated that pain intensity significantly mediated the effect of happiness on pain interference (indirect effect: β = -0.13, P Happiness showed a significant direct effect on pain intensity (β = -0.20, P happiness components meaning, pleasure, and engagement fitted well (χ2(4) = 9.65, P = 0.05, root-mean-square error of approximation = 0.055). Pain intensity acted as a significant mediator but only mediated the effect of meaning on pain interference (indirect effect: β = -0.07, P = 0.05) and on distress (indirect effect via pain interference: β = -0.04, P = 0.05). Only meaning (β = -0.10, P = 0.05), but neither pleasure nor engagement, had a significant direct effect on pain intensity. Participants who reported greater happiness reported lower pain interference and distress through happiness' effects on pain intensity. Experiencing meaning and purpose in life seems to be most closely (and negatively) associated with pain intensity, pain interference, and distress. Findings from this study can lay the groundwork for intervention studies to better understand how to more effectively decrease pain intensity, pain interference, and distress.

Do pain-associated contexts increase pain sensitivity? An investigation using virtual reality.

Science.gov (United States)

Harvie, Daniel S; Sterling, Michele; Smith, Ashley D

2018-04-30

Pain is not a linear result of nociception, but is dependent on multisensory inputs, psychological factors, and prior experience. Since nociceptive models appear insufficient to explain chronic pain, understanding non-nociceptive contributors is imperative. Several recent models propose that cues associatively linked to painful events might acquire the capacity to augment, or even cause, pain. This experiment aimed to determine whether contexts associated with pain, could modulate mechanical pain thresholds and pain intensity. Forty-eight healthy participants underwent a contextual conditioning procedure, where three neutral virtual reality contexts were paired with either unpredictable noxious stimulation, unpredictable vibrotactile stimulation, or no stimulation. Following the conditioning procedure, mechanical pain thresholds and pain evoked by a test stimulus were examined in each context. In the test phase, the effect of expectancy was equalised across conditions by informing participants when thresholds and painful stimuli would be presented. Contrary to our hypothesis, scenes that were associated with noxious stimulation did not increase mechanical sensitivity (p=0.08), or increase pain intensity (p=0.46). However, an interaction with sex highlighted the possibility that pain-associated contexts may alter pain sensitivity in females but not males (p=0.03). Overall, our data does not support the idea that pain-associated contexts can alter pain sensitivity in healthy asymptomatic individuals. That an effect was shown in females highlights the possibility that some subgroups may be susceptible to such an effect, although the magnitude of the effect may lack real-world significance. If pain-associated cues prove to have a relevant pain augmenting effect, in some subgroups, procedures aimed at extinguishing pain-related associations may have therapeutic potential.

Operant conditioning of enhanced pain sensitivity by heat-pain titration.

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Becker, Susanne; Kleinböhl, Dieter; Klossika, Iris; Hölzl, Rupert

2008-11-15

Operant conditioning mechanisms have been demonstrated to be important in the development of chronic pain. Most experimental studies have investigated the operant modulation of verbal pain reports with extrinsic reinforcement, such as verbal reinforcement. Whether this reflects actual changes in the subjective experience of the nociceptive stimulus remained unclear. This study replicates and extends our previous demonstration that enhanced pain sensitivity to prolonged heat-pain stimulation could be learned in healthy participants through intrinsic reinforcement (contingent changes in nociceptive input) independent of verbal pain reports. In addition, we examine whether different magnitudes of reinforcement differentially enhance pain sensitivity using an operant heat-pain titration paradigm. It is based on the previously developed non-verbal behavioral discrimination task for the assessment of sensitization, which uses discriminative down- or up-regulation of stimulus temperatures in response to changes in subjective intensity. In operant heat-pain titration, this discriminative behavior and not verbal pain report was contingently reinforced or punished by acute decreases or increases in heat-pain intensity. The magnitude of reinforcement was varied between three groups: low (N1=13), medium (N2=11) and high reinforcement (N3=12). Continuous reinforcement was applied to acquire and train the operant behavior, followed by partial reinforcement to analyze the underlying learning mechanisms. Results demonstrated that sensitization to prolonged heat-pain stimulation was enhanced by operant learning within 1h. The extent of sensitization was directly dependent on the received magnitude of reinforcement. Thus, operant learning mechanisms based on intrinsic reinforcement may provide an explanation for the gradual development of sustained hypersensitivity during pain that is becoming chronic.

Child pain catastrophizing mediates the relation between parent responses to pain and disability in youth with functional abdominal pain.

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Cunningham, Natoshia R; Lynch-Jordan, Anne; Barnett, Kimberly; Peugh, James; Sil, Soumitri; Goldschneider, Kenneth; Kashikar-Zuck, Susmita

2014-12-01

Functional abdominal pain (FAP) in youth is associated with substantial impairment in functioning, and prior research has shown that overprotective parent responses can heighten impairment. Little is known about how a range of parental behaviors (overprotection, minimizing, and/or encouragement) in response to their child's pain interact with child coping characteristics (eg, catastrophizing) to influence functioning in youth with FAP. In this study, it was hypothesized that the relation between parenting factors and child disability would be mediated by children's levels of maladaptive coping (ie, pain catastrophizing). Seventy-five patients with FAP presenting to a pediatric pain clinic and their caregivers participated in the study. Youth completed measures of pain intensity (Numeric Rating Scale), pain catastrophizing (Pain Catastrophizing Scale), and disability (Functional Disability Inventory). Caregivers completed measures of parent pain catastrophizing (Pain Catastrophizing Scale), and parent responses to child pain behaviors (Adult Responses to Child Symptoms: Protection, Minimizing, and Encouragement/Monitoring subscales). Increased functional disability was significantly related to higher child pain intensity, increased child and parent pain catastrophizing, and higher levels of encouragement/monitoring and protection. Parent minimization was not related to disability. Child pain catastrophizing fully mediated the relation between parent encouragement/monitoring and disability and partially mediated the relation between parent protectiveness and disability. The impact of parenting behaviors in response to FAP on child disability is determined, in part, by the child's coping style. Findings highlight a more nuanced understanding of the parent-child interaction in determining pain-related disability levels, which should be taken into consideration in assessing and treating youth with FAP.

Glia and pain: is chronic pain a gliopathy?

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Ji, Ru-Rong; Berta, Temugin; Nedergaard, Maiken

2013-12-01

Activation of glial cells and neuro-glial interactions are emerging as key mechanisms underlying chronic pain. Accumulating evidence has implicated 3 types of glial cells in the development and maintenance of chronic pain: microglia and astrocytes of the central nervous system (CNS), and satellite glial cells of the dorsal root and trigeminal ganglia. Painful syndromes are associated with different glial activation states: (1) glial reaction (ie, upregulation of glial markers such as IBA1 and glial fibrillary acidic protein (GFAP) and/or morphological changes, including hypertrophy, proliferation, and modifications of glial networks); (2) phosphorylation of mitogen-activated protein kinase signaling pathways; (3) upregulation of adenosine triphosphate and chemokine receptors and hemichannels and downregulation of glutamate transporters; and (4) synthesis and release of glial mediators (eg, cytokines, chemokines, growth factors, and proteases) to the extracellular space. Although widely detected in chronic pain resulting from nerve trauma, inflammation, cancer, and chemotherapy in rodents, and more recently, human immunodeficiency virus-associated neuropathy in human beings, glial reaction (activation state 1) is not thought to mediate pain sensitivity directly. Instead, activation states 2 to 4 have been demonstrated to enhance pain sensitivity via a number of synergistic neuro-glial interactions. Glial mediators have been shown to powerfully modulate excitatory and inhibitory synaptic transmission at presynaptic, postsynaptic, and extrasynaptic sites. Glial activation also occurs in acute pain conditions, and acute opioid treatment activates peripheral glia to mask opioid analgesia. Thus, chronic pain could be a result of "gliopathy," that is, dysregulation of glial functions in the central and peripheral nervous system. In this review, we provide an update on recent advances and discuss remaining questions. Copyright © 2013 International Association for the

Atypical electrophysiological activity during pain observation in amputees who experience synaesthetic pain

OpenAIRE

Fitzgibbon, Bernadette M.; Enticott, Peter G.; Giummarra, Melita J.; Thomson, Richard H.; Georgiou-Karistianis, Nellie; Bradshaw, John L.

2011-01-01

There are increasing reports of people experiencing pain when observing pain in another. This describes the phenomenon of synaesthetic pain which, until recently, had been primarily reported in amputees with phantom pain. In the current study, we used electroencephalography (EEG) to investigate how amputees who experience synaesthetic pain process pain observed in another. Participants were grouped according to amputees who experience phantom and synaesthetic pain (n = 8), amputees who experi...

Pain after earthquake

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Angeletti Chiara

2012-06-01

Full Text Available Abstract Introduction On 6 April 2009, at 03:32 local time, an Mw 6.3 earthquake hit the Abruzzi region of central Italy causing widespread damage in the City of L Aquila and its nearby villages. The earthquake caused 308 casualties and over 1,500 injuries, displaced more than 25,000 people and induced significant damage to more than 10,000 buildings in the L'Aquila region. Objectives This observational retrospective study evaluated the prevalence and drug treatment of pain in the five weeks following the L'Aquila earthquake (April 6, 2009. Methods 958 triage documents were analysed for patients pain severity, pain type, and treatment efficacy. Results A third of pain patients reported pain with a prevalence of 34.6%. More than half of pain patients reported severe pain (58.8%. Analgesic agents were limited to available drugs: anti-inflammatory agents, paracetamol, and weak opioids. Reduction in verbal numerical pain scores within the first 24 hours after treatment was achieved with the medications at hand. Pain prevalence and characterization exhibited a biphasic pattern with acute pain syndromes owing to trauma occurring in the first 15 days after the earthquake; traumatic pain then decreased and re-surged at around week five, owing to rebuilding efforts. In the second through fourth week, reports of pain occurred mainly owing to relapses of chronic conditions. Conclusions This study indicates that pain is prevalent during natural disasters, may exhibit a discernible pattern over the weeks following the event, and current drug treatments in this region may be adequate for emergency situations.

The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions.

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Fillingim, Roger B; Bruehl, Stephen; Dworkin, Robert H; Dworkin, Samuel F; Loeser, John D; Turk, Dennis C; Widerstrom-Noga, Eva; Arnold, Lesley; Bennett, Robert; Edwards, Robert R; Freeman, Roy; Gewandter, Jennifer; Hertz, Sharon; Hochberg, Marc; Krane, Elliot; Mantyh, Patrick W; Markman, John; Neogi, Tuhina; Ohrbach, Richard; Paice, Judith A; Porreca, Frank; Rappaport, Bob A; Smith, Shannon M; Smith, Thomas J; Sullivan, Mark D; Verne, G Nicholas; Wasan, Ajay D; Wesselmann, Ursula

2014-03-01

Current approaches to classification of chronic pain conditions suffer from the absence of a systematically implemented and evidence-based taxonomy. Moreover, existing diagnostic approaches typically fail to incorporate available knowledge regarding the biopsychosocial mechanisms contributing to pain conditions. To address these gaps, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration and the American Pain Society (APS) have joined together to develop an evidence-based chronic pain classification system called the ACTTION-APS Pain Taxonomy. This paper describes the outcome of an ACTTION-APS consensus meeting, at which experts agreed on a structure for this new taxonomy of chronic pain conditions. Several major issues around which discussion revolved are presented and summarized, and the structure of the taxonomy is presented. ACTTION-APS Pain Taxonomy will include the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. In coming months, expert working groups will apply this taxonomy to clusters of chronic pain conditions, thereby developing a set of diagnostic criteria that have been consistently and systematically implemented across nearly all common chronic pain conditions. It is anticipated that the availability of this evidence-based and mechanistic approach to pain classification will be of substantial benefit to chronic pain research and treatment. The ACTTION-APS Pain Taxonomy is an evidence-based chronic pain classification system designed to classify chronic pain along the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial

Analyzing musculoskeletal neck pain, measured as present pain and periods of pain, with three different regression models: a cohort study

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Hagberg Mats

2009-06-01

Full Text Available Abstract Background In the literature there are discussions on the choice of outcome and the need for more longitudinal studies of musculoskeletal disorders. The general aim of this longitudinal study was to analyze musculoskeletal neck pain, in a group of young adults. Specific aims were to determine whether psychosocial factors, computer use, high work/study demands, and lifestyle are long-term or short-term factors for musculoskeletal neck pain, and whether these factors are important for developing or ongoing musculoskeletal neck pain. Methods Three regression models were used to analyze the different outcomes. Pain at present was analyzed with a marginal logistic model, for number of years with pain a Poisson regression model was used and for developing and ongoing pain a logistic model was used. Presented results are odds ratios and proportion ratios (logistic models and rate ratios (Poisson model. The material consisted of web-based questionnaires answered by 1204 Swedish university students from a prospective cohort recruited in 2002. Results Perceived stress was a risk factor for pain at present (PR = 1.6, for developing pain (PR = 1.7 and for number of years with pain (RR = 1.3. High work/study demands was associated with pain at present (PR = 1.6; and with number of years with pain when the demands negatively affect home life (RR = 1.3. Computer use pattern (number of times/week with a computer session ≥ 4 h, without break was a risk factor for developing pain (PR = 1.7, but also associated with pain at present (PR = 1.4 and number of years with pain (RR = 1.2. Among life style factors smoking (PR = 1.8 was found to be associated to pain at present. The difference between men and women in prevalence of musculoskeletal pain was confirmed in this study. It was smallest for the outcome ongoing pain (PR = 1.4 compared to pain at present (PR = 2.4 and developing pain (PR = 2.5. Conclusion By using different regression models different

How well do clinical pain assessment tools reflect pain in infants?

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Rebeccah Slater

2008-06-01

Full Text Available Pain in infancy is poorly understood, and medical staff often have difficulty assessing whether an infant is in pain. Current pain assessment tools rely on behavioural and physiological measures, such as change in facial expression, which may not accurately reflect pain experience. Our ability to measure cortical pain responses in young infants gives us the first opportunity to evaluate pain assessment tools with respect to the sensory input and establish whether the resultant pain scores reflect cortical pain processing.Cortical haemodynamic activity was measured in infants, aged 25-43 wk postmenstrual, using near-infrared spectroscopy following a clinically required heel lance and compared to the magnitude of the premature infant pain profile (PIPP score in the same infant to the same stimulus (n = 12, 33 test occasions. Overall, there was good correlation between the PIPP score and the level of cortical activity (regression coefficient = 0.72, 95% confidence interval [CI] limits 0.32-1.11, p = 0.001; correlation coefficient = 0.57. Of the different PIPP components, facial expression correlated best with cortical activity (regression coefficient = 1.26, 95% CI limits 0.84-1.67, p < 0.0001; correlation coefficient = 0.74 (n = 12, 33 test occasions. Cortical pain responses were still recorded in some infants who did not display a change in facial expression.While painful stimulation generally evokes parallel cortical and behavioural responses in infants, pain may be processed at the cortical level without producing detectable behavioural changes. As a result, an infant with a low pain score based on behavioural assessment tools alone may not be pain free.

Toni Morrison's Beloved: a journey through the pain of grief.

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Pass, Olivia McNeely

2006-01-01

This paper elucidates the structure of Toni Morrison's novel, Beloved, using the framework of human emotions in response to grieving and death as developed by Elisabeth Kubler-Ross. Through her studies of terminally ill patients, Kubler-Ross identified five stages when approaching death: denial and isolation, anger, bargaining, depression and acceptance. These stages accurately fill the process that the character Sethe experiences in the novel as she learns to accept her daughter's death.

Early visceral pain predicts chronic pain after laparoscopic cholecystectomy

DEFF Research Database (Denmark)

Blichfeldt-Eckhardt, Morten Rune; Ording, Helle; Andersen, Claus

2014-01-01

Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1week postoperatively...

Pain cognition versus pain intensity in patients with endometriosis: toward personalized treatment.

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van Aken, Mieke A W; Oosterman, Joukje M; van Rijn, C M; Ferdek, Magdalena A; Ruigt, Gé S F; Peeters, B W M M; Braat, Didi D M; Nap, Annemiek W

2017-10-01

To explore how pain intensity and pain cognition are related to health-related quality of life (HRQoL) in women with endometriosis. Cross-sectional questionnaire-based survey. Multidisciplinary referral center. Women with laparoscopically and/or magnetic resonance imaging-proven endometriosis (n = 50) and healthy control women (n = 42). For HRQoL, two questionnaires: the generic Short Form Health Survey (SF-36) and the Endometriosis Health Profile 30 (EHP-30). For pain cognition, three questionnaires: the Pain Catastrophizing Scale (PCS), the Pain Vigilance and Awareness Questionnaire (PVAQ), and the Pain Anxiety Symptoms Scale (PASS). For pain intensity, the verbal Numeric Rating Scale (NRS). Association between pain intensity and pain cognition with HRQoL in women with endometriosis, and the differences in HRQoL and pain cognition between women with endometriosis and healthy controls. Health-related quality of life was statistically significantly impaired in women with endometriosis as compared with healthy control women. The variables of pain intensity and pain cognition were independent factors influencing the HRQoL of women with endometriosis. Patients with endometriosis had statistically significantly more negative pain cognition as compared with controls. They reported more pain anxiety and catastrophizing, and they were hypervigilant toward pain. Pain cognition is independently associated with the HRQoL in endometriosis patients. Clinicians should be aware of this phenomenon and may consider treating pain symptoms in a multidimensional, individualized way in which the psychological aspects are taken into account. In international guidelines on management of women with endometriosis more attention should be paid to the psychological aspects of care. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Child pain catastrophizing mediates the relationship between parent responses to pain and disability in youth with functional abdominal pain

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Cunningham, Natoshia Raishevich; Lynch-Jordan, Anne; Barnett, Kimberly; Peugh, James; Sil, Soumitri; Goldschneider, Kenneth; Kashikar-Zuck, Susmita

2014-01-01

Objectives Functional abdominal pain (FAP) in youth is associated with substantial impairment in functioning and prior research has shown that overprotective parent responses can heighten impairment. Little is known about how a range of parental behaviors in response to their child’s pain (overprotection, minimizing and/or encouragement) interact with child coping characteristics (e.g., catastrophizing) to influence functioning in youth with FAP. In this study, it was hypothesized that the relationship between parenting factors and child disability would be mediated by children’s level of maladaptive coping (i.e., pain catastrophizing). Methods Seventy-five patients with FAP presenting to a pediatric pain clinic and their caregivers participated. Youth completed measures of pain intensity (Numeric Rating Scale), pain catastrophizing (Pain Catastrophizing Scale), and disability (Functional Disability Inventory). Caregivers completed measures of parent pain catastrophizing (Pain Catastrophizing Scale), and parent responses to child pain behaviors (Adult Responses to Child Symptoms: protection, minimizing, and encouragement/monitoring subscales). Results Increased functional disability was significantly related to higher child pain intensity, increased child and parent pain catastrophizing, and higher levels of encouragement/monitoring and protection. Parent minimization was not related to disability. Child pain catastrophizing fully mediated the relationship between parent encouragement/monitoring and disability and partially mediated the relationship between parent protectiveness and disability. Conclusions The impact of parenting behaviors in response to FAP on child disability is determined in part by the child’s coping style. Findings highlight a more nuanced understanding of the parent-child interaction in determining pain-related disability levels, which should be taken into consideration in assessing and treating youth with FAP. PMID:25121521

Epidemiology of chronic pain in the office of a pain specialist neurologist

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Karen dos Santos Ferreira

2015-07-01

Full Text Available Objective The objective of the present report was to describe the working experience of a pain specialist neurologist after concluding a medical residency program on neurology, area of concentration pain. Method A retrospective study was conducted for one year in the office of a pain specialist neurologist. Patients older than 18 years with chronic pain according to the criteria of the International Association for the Study of Pain, were included. Demographic data, chronic pain data and the treatments instituted were investigated. Results A total of 241 medical records were reviewed, mean patient age was 52.4 years and 79 (66.9% were women, and the mean score on a numeric pain scale was 8.69. The diagnoses were headaches (74.6%, neuropathic pain (17% and ostheomuscular pain (8.2%. We did not detect cancer pain. Patients received medication and procedures of anesthetic blockade. Conclusion This data can guide new medical residency programs on Neurology, area of concentration pain, to plan activities and studies.