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.

Experience in Competitive Youth Sport and Needs Satisfaction: The Singapore Story

The purpose of this study was to examine the relationship between sport experiences and psychological needs satisfaction of Singapore high school athletes who were involved in inter-school competition. A total of 1250 school athletes from 22 sports participated in the study. The athletes were between 13 and 18 years old and had an average of 3 years of experience in school sport (SD=.18). Cluster analysis was employed to identify homogenous groups based on the seven developmental experiences domains of the Youth Experience Survey (YES 2.0; Hansen & Larson, 2005). A one-way analysis of variance (ANOVA) was conducted to determine whether differences existed among the clusters in terms of psychological needs satisfaction (i.e., sense of autonomy, perceived competence and relatedness). The results of the cluster analysis showed that there were different subgroups of athletes with distinct developmental experiences, and they varied in the degree to which their psychological needs were satisfied. Generally, subgroups that had high levels of positive experiences and low levels of negative experiences in sport had better fulfillment of psychological needs. It is important to ensure that policies and programmes are formulated, delivered and monitored effectively to promote positive experiences for youth who are involved in competitive sports.

MNEMOSYNE: NARRATING A PAKHTUN STUDENT’S FOREIGN CURRICULAR EXPERIENCE

Studying abroad is generally viewed as an opportunity for personal and educational transformation for students. In recent years, various studies have been conducted in the area of study abroad. Most of these studies primarily involve quantitative analyses, and do not fully explore the lived experience of this opportunity. Recently, researchers have started exploring the qualitative aspects and impact of studying abroad, but from an external perspective. This study attends to the phenomenon of a foreign curricular experience from an insider’s perspective and explicates the experience through a personal narrative. Countries usually have educational curricula that serve their particular needs. The rise of the number of students studying abroad has made study abroad a lucrative industry but it has also increasingly exposed foreign students to curricula that are different than those of their countries of origin. Subjecting students to dissimilar, and sometimes competing, curricula interrupts their habitual ways of knowing and being. My study is a qualitative study that explores the foreign curricular experience of one Pakhtun student. Specifically, through an autobiography, this study aims to explore how a foreign curricular experience acts as a ‘transitional space’ for a student and how it deeply affects her learning self and identity. This study contributes to the body of literature on the effects of a foreign curriculum on study abroad students by adding narrative to explain the lived experience of studying abroad.