In this thesis, rodent models of chronic pain were used to explore analgesic mechanisms that may potentially be engaged in spinal and peripheral compartments by systemically-administered amitriptyline, a tricyclic antidepressant. The first project (Chapter 2) identified the roles of spinal adenosine A1 and serotonin 5-HT7 receptors, as well as of peripheral adenosine A1 receptors, in the acute antinociceptive effects of amitriptyline in mice. The second project (Chapter 3) examined the potential utility of amitriptyline as a preventive analgesic against persistent post-surgical pain, and involved perioperative administration of amitriptyline after peripheral nerve injury in rats. Changes in post-injury behavioural outcomes, as well as spinal noradrenergic sprouting, were assessed. Overall, spinal serotonergic pathways linked to adenosine A1 receptors, as well as peripheral adenosine A1 receptors, appear to be important in antinociception by amitriptyline. Preventive analgesia by this drug does not appear to result from anatomical changes in spinal noradrenergic pathways. Advisors/Committee Members: Kazue Semba (external-examiner), Eileen Denovan-Wright (graduate-coordinator), Jason McDougall (thesis-reader), Jana Sawynok (thesis-supervisor), Received (ethics-approval), Not Applicable (manuscripts), Not Applicable (copyright-release).

International and national use of complementary and alternative medicine (CAM) is high in the general population and among patients. The level of knowledge about CAM among health care professions is low, but an interest in receiving education about this field has been observed. Concerning surgical care, previous studies indicate a wide range of CAM use among patients, but the level of knowledge among health care professions is poorly investigated, both internationally and in Sweden. Concerning CAM therapies in the management of signs and symptoms in surgical care, transcutaneous electric nerve stimulation (TENS) was used with a variety of effectiveness and osteopathic medicine was found to be poorly investigated in this context. The overall objective of this thesis was to investigate CAM in the surgical context with a focus on health care professions’ perceptions and understanding and the usefulness of therapy in symptom management in clinical settings. Both inductive (paper I; semi structured interviews, n=16) and deductive (paper II; questionnaire, n=737) methods were used to investigate perceptions and understanding of CAM among Swedish health care professions in surgical care. TENS as a pain relieving complement during the transition from epidural analgesia (EDA) to general analgesia after major abdominal surgery was investigated in a randomized controlled trial design (paper III; n=20). Osteopathic intervention in management of chronic signs and symptoms after thoracotomy was investigated with a single-subject research design (paper IV; n=8). The results reveal that surgical health care professions understand and perceive CAM as a wide range of therapies, remedies and systems. Their self valued level of knowledge was low, both concerning CAM and CAM research, but a desire was found to gain knowledge about CAM. A majority of the participants would consider learning a CAM therapy. Dialog about and referral to CAM occurred, but to a limited extent. Concerning therapy usability, TENS was not found to significantly relieve pain, promote recovery or reduce consumption of analgesics. In addition, comments from nurses and patients indicated that TENS treatment obstructed postoperative care. A significant improvement was observed in the osteopathic intervention in stiffness and benefits for pain, but not in breathing. The comprehensive conclusion of the thesis is that Swedish health care professions recognise the concept of CAM and some of its therapies, but their knowledge is in general low. Concerning therapy usability and the effectiveness of CAM in surgical care, the context is essential; TENS after major abdominal surgery in EDA elimination is questionable as concerns pain and its clinical application, while osteopathy may be beneficial in the management of chronic signs and symptoms after thoracotomy.