Self-Management of Chronic Pain: Interventions, Strategies, Barriers, and Facilitators

Background & Purpose: Chronic pain is a prevalent chronic condition for which the best management options rarely provide complete relief. Individuals with chronic pain with neuropathic characteristics (NC) report more severe pain and experience less relief from interventions. Little is known about current self-management practices. The purpose of this dissertation was to inform self-management of chronic pain with and without NC at the individual, health system, and policy levels using the Innovative Care for Chronic Conditions Framework. Methods: The study included a systematic search and review and cross-sectional survey. The review evaluated the evidence for chronic pain self-management interventions and explored the role of health care providers in supporting self-management. The survey was mailed to 8,000 randomly selected Canadians in November 2011, and non-respondents were followed-up in May 2012. Screening questions were included for both chronic pain and NC. The questionnaire captured pain descriptions, self-management strategies, and self-management barriers, and facilitators. Results: Findings of the review suggested that self-management interventions are effective in improving pain and health outcomes. Health care professionals provided self-management advice and referred individuals to self-management interventions. The questionnaire was completed by 1,520 Canadians. Those with chronic pain (n=710) identified primary care physicians as the most helpful pain management professional. Overall, use of non-pharmaceutical medical self-management strategies was low. While use positive emotional self-management strategies was high, individuals with NC were more likely to use negative emotional self-management strategies compared to those without NC. Multiple self-management barriers and facilitators were identified, however those with NC were more likely than those without NC to experience low self-efficacy, depression and severe pain which may impair the ability to self-management. Conclusions: Health care professionals have the opportunity to improve chronic pain outcomes by providing self-management advice, referring to self-management interventions, and addressing self-management barriers and facilitators. Individuals with NC may require additional health services to address their greater self-management challenges, and further research is needed to identify non-pharmaceutical interventions effective in relieving chronic pain with NC. Public policy is needed to facilitate health systems in providing long-term self-management support for individuals with chronic pain.

Radical Ambition: A Portrait of the Toronto New Left, 1958-1985

This thesis examines the rise and decline of the New Left in Toronto from 1958 to 1985. It argues that New Leftism — whose three leading ideals were self-management, national liberation, and community — arose as much from the Old Left as it did from the peace movement. In contrast to earlier readings that interpret the New Left narrowly — essentially, as the combined forces of the white student and peace movements evident mainly on university campuses — this thesis documents the extent to which New Leftism, interpreted as a political formation, provided a framework for a diversity of radical social movements, especially feminism, Black Power, gay liberation, resistance to the capitalist redevelopment of the city, and transnational solidarity. It also questions a declensionist narrative that adopts a “decadal” approach to the radicalism of the sixties, according to which 1970 spelled the end of “60s” radicalism. Quite the contrary, this thesis argues: in Toronto, it would be truer to say that 1970s were “the sixties,” in that only in this later decade did many New Left movements attain their full maturity. New Leftists successfully challenged a host of institutions, sometimes with permanent effects. The educational system was transformed. Cultural institutions and practices were revolutionized. Questions of race and gender, once peripheral to the left, were made central to it. Democratic community institutions became far more powerful. A token of the strength and durability of the New Left in Toronto was the extent to which it remained the bête noir of a series of other radical groups upholding the model of the vanguard communist party — which challenged the New Leftists’ prominence but many members of which often wound up agreeing with their positions. It was only in the early 1980s, with the ascent of a new right, that Toronto’s New Left unmistakably entered a period of decline. Yet, even then, many of its key themes were picked up by fast-growing anarchist and socialist feminist currents. Far from constituting a minor phenomenon, Toronto’s New Left, one of the largest movements for social justice in Canadian history, bequeathed to its progressive successors an imposing legacy of struggle and cultural achievements. It is the purpose of this thesis to evaluate, both critically and sympathetically, the extent to which the New Left attained its radical ambition.