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.

Bioaccumulation Trends of Ten Metals in a Pelagic Food Web of Lake Champlain

Many metals have serious toxic effects when ingested by aquatic organisms, and the process of bioaccumulation intensifies this problem. A better understanding of bioaccumulation trends of anthropogenically introduced metals in freshwater food webs is necessary for the development of effective management strategies to protect aquatic organisms, as well as organisms (including humans) that consume top-predator fish in these food webs. Various fish species representing different trophic levels of a pelagic food chain were sampled from Lake Champlain (VT/NY). Atomic absorption spectrometry (AAS) was used to determine levels of chromium, copper, cobalt, cadmium, lead, zinc, nickel, rubidium, cesium and potassium in the fish samples. Metal concentrations for chromium, cobalt, nickel, cesium, cadmium (<5.0 ppm) and lead (<10.0 ppm) were found to be all below detection limits. Carbon and nitrogen isotopic ratios were analyzed to determine the trophic relationship of each fish species. Stable isotope and AAS metal data were used in tandem to produce linear regressions for each metal against trophic level to assess biomagnification. Both potassium and zinc showed no biomagnification because they are homeostatically regulated essential trace metals. Copper was under the detection limits for all fish species with the exception of the sea lamprey; but showed a significant biodiminution among the invertebrates and lamprey. Rubidium, a rarely studied metal, was shown to increase with trophic level in a marginally significant linear relationship suggesting biomagnification is possible where more trophic levels are sampled.