Search Results (817)

Background/Objectives: Adolescent idiopathic scoliosis (AIS) often requires prolonged brace use to prevent curve progression. However, adherence is challenging due to discomfort, mobility restrictions, and psychosocial stressors. This study evaluated the feasibility and clinical utility of a mobile health (mHealth) system for real-time tracking of brace adherence and treatment-related experiences in adolescents with AIS. Methods: Thirty adolescents with AIS (mean age = 12.9, SD = 1.8) undergoing brace treatment at a tertiary care center used a custom app for 90 days. The app collected daily self-reports on brace wear duration, discomfort, movement limitations, emotional distress, and social challenges. A clinical alarm system alerted providers when patient input indicated potential concerns. Primary outcomes were feasibility (adherence to daily use and usability ratings) and brace adherence. Secondary outcomes included the app’s capacity to identify treatment-related challenges and its association with changes in stress, quality of life, anxiety, and depression. Results: Participants reported meeting recommended brace wear time (≥16 h/day) on 84.8% of days. The app triggered 186 clinical alarms, with the most frequent related to emotional distress (23.1%) and pain (15.6%). Alarm frequency declined over time. Improvements of ≥20% in psychological outcomes were observed in 20–26.7% of participants, while group-level changes were nonsignificant. Conclusions: mHealth-based monitoring appears feasible and acceptable for digitally engaged adolescents with AIS. The app supported early detection of treatment barriers and prompted timely clinical responses. Despite limitations, it shows promise as a tool to improve treatment engagement and address psychosocial challenges in scoliosis care. Full article

Background: Regulating sensations of fatigue and discomfort while performing maximal endurance exercise becomes essential for making informed decisions about persistence and/or failure during intense exercise. Athletes with a higher effort capacity have competitive advantages over those with a lower one. The microbiota–brain axis is a considered the sixth sense and a modulator of the host’s emotional stability and physical well-being. Objectives: This narrative review aims to explore and evaluate the potential mechanisms involved in regulating perceptions during endurance exercise, with a focus on the possible relationship between the gut microbiota balance and the neural system as an adaptive response to high fatigue chronic exposure. Methods: Electronic databases (PubMed, Web of Science, Google Scholar, and Scopus) were used to identify studies and hypotheses that had documented predefined search terms related to endurance exercise, gut microbiota, the central nervous system, pain, discomfort, fatigue, and tolerance to effort. Results: This narrative review shifts the focus concerning the symbiotic relationship between the gut microbiota, the vagus nerve, the central/enteric nervous system, and the regulation of afferences from different organs and systems to manage discomfort and fatigue perceptions during maximal physical effort. Consequently, the chronicity supporting fatigued exercise and nutritional stimuli could specifically adapt the microbiota–brain connection through chronic efferences and afferences. The present hypothesis could represent a new focus to be considered, analysing individual differences in tolerating fatigue and discomfort in athletes supporting conditions of intense endurance exercise. Conclusions: A growing body of evidence suggests that the gut microbiota has rapid adaptations to afferences from the brain axis, with a possible relationship to the management of fatigue, pain, and discomfort. Therefore, the host–microbiota relationship could determine predisposition to endurance performance by increasing thresholds of sensitive afferences perceived and tolerated. A richer and more diverse GM of athletes in comparison with sedentary subjects can improve the bacteria-producing metabolites connected to brain activity related with fatigue. The increase in fatigue thresholds directly improves exercise performance, and the gut–brain axis may contribute through the equilibrium of metabolites produced for the microbiota. Full article

Fear modulates intergroup dynamics by amplifying biases, yet prior work predominantly examines integrated emotions (e.g., fear tied to intergroup conflict), neglecting incidental fear—transient states unrelated to group contexts. Furthermore, the reliance on Western samples limits insights into cultural variability, particularly in collectivist societies where group boundaries differ. Here, we conducted two experimental studies that involved Chinese participants and examined the effect of incidental fear on empathy for in-group and out-group members’ pain (operationalized as self-focused empathy, reflecting personal distress when witnessing pain, and other-focused empathy, reflecting compassionate concern for the sufferer). In Experiment 1 (N = 54), using a pain observation paradigm, incidental fear was elicited by randomly showing frightening images, while the differentiation between the in-group and out-group was based on natural ethnic differences (same races and other races). Experiment 2 (N = 52) replicated this using artificial social categorization (university affiliation). Fear reduced other-focused empathy for racial out-groups and socially defined out-groups. Self-focused empathy remained unaffected, suggesting fear selectively disrupts mentalizing-dependent processes. The Inclusion of Other in Self (IOS) scale revealed heightened psychological distance toward out-groups under fear, mediating empathy reduction. Incidental fear universally diminishes empathy for out-group pain across natural and artificial group boundaries, extending social identity theory to transient affective states. These findings highlight fear’s role in intergroup bias and underscore cultural generalizability beyond WEIRD populations. Full article

Background. Living with a stoma entails profound changes in a person’s life, affecting physical, psychological, and social well-being. Patients often face challenges related to body image, interpersonal relationships, and self-esteem. A stoma can impair quality of life, trigger feelings of shame and limit freedom of movement. Objectives. To assess the subjective perception of quality of life and related psychophysical consequences in individuals with an intestinal stoma. To evaluate the level of perceived support from healthcare professionals involved in the care pathway. Methods. This is a descriptive observational study conducted through the administration of an online questionnaire. The sample includes 189 adult patients with an intestinal stoma. Results. Data analysis revealed that participants aged ≥65 years and those with a permanent stoma reported higher quality of life scores compared to younger individuals or those with a temporary stoma. An inverse correlation emerged between quality of life and perceived stress (p < 0.001); in particular, pain and social embarrassment were strongly associated with higher levels of stress. The enterostomal therapy nurse was identified as a key figure in the care pathway (70.4%). Conclusions. The findings highlight the need for person-centered care that addresses not only clinical aspects but also emotional and relational dimensions. Enhancing the role of trained professionals, such as enterostomal therapy nurses, and promoting targeted educational interventions may contribute to improving the quality of life in patients living with a stoma. Full article

In this perspective article, we introduce Ecocebo as a novel concept describing the modulatory effects of physical environments, whether natural or built, on drug effect. Positioned as a spatial component of the placebo effect, Ecocebo is grounded in evidence-based design principles and proposes that environmental features such as natural light, greenery, spatial geometry, and calming esthetics can significantly influence sensory, emotional, and cognitive processes. These environmental factors may enhance or modify pharmacological responses, especially for analgesics, anxiolytics, and antidepressants. We highlighted how exposure to restorative spaces can reduce pain perception, stress, and the need for medication, paralleling findings in placebo research where contextual and sensory cues influence brain regions linked to emotion and pain regulation. We propose virtual reality (VR) as the most suitable methodological tool to study Ecocebo in controlled and ecologically valid settings. VR allows for the precise manipulation of spatial features and real-time monitoring of physiological and psychological responses. We also propose integrating VR with neuromodulation techniques to investigate brain–environment–drug interactions. Finally, we addressed key methodological challenges such as defining control conditions and standardizing the measurement of presence. This perspective opens new directions for the integration of non-pharmacological and pharmacological interventions and personalized therapeutic environments to optimize clinical outcomes. Full article

Background/Objectives: This study assessed how to best prepare pediatric and adolescent cancer patients for amputation and support them afterward. Methods: This pilot qualitative study explored pre- and post-amputation experiences from the perspectives of nine pediatric and adolescent survivors who underwent amputation. Hour-long audio-recorded semi-structured interviews were transcribed and analyzed using the Sort and Sift, Think and Shift qualitative approach. Results: Participants described the informational supports they received before surgery, including guidance on what to expect, contact with amputation-related organizations, and exposure to tangible tools, such as a physical model of a knee joint. Emotional support from fellow amputees and healthcare providers, particularly surgeons, was also found to be meaningful. Individuals also identified unmet needs and gaps in emotional care. These included clearer guidance on post-surgical adaptations (e.g., basic self-care and navigating physical limitations) and the need for information tailored to their learning styles. Many emphasized the importance of improved pain management resources, expanded access to mental health services for both them and their families, and support in adjusting to changes in body image and social relationships. Participants also shared advice for future patients, recommending strategies such as personalizing hospital rooms, connecting with other amputees through social media, and using art to process their experience and say goodbye to the lost limb. Conclusions: Interviews with nine cancer survivors provide guidance for improving holistic, patient-centered care throughout the amputation process. Informational and emotional support should be tailored to an individual’s learning style and specific needs, in addition to their age at the time of surgery. Full article

Introduction. Chronic pain (CP) is a multidimensional condition that exerts a considerable impact on individuals’ quality of life and presents a wide range of clinical and psychological expressions. This study sought, firstly, to identify distinct clinical profiles among individuals with CP based on clinical indicators, and secondly, to examine the differences in psychological vulnerability and pain-related coping strategies according to the clinical profiles. Methods. A total of 251 adults diagnosed with CP and residing in Spain participated in the study. Participants completed the Purpose in Life Test, the Reflective Functioning Questionnaire, the Interpersonal Needs Questionnaire, the Beck Hopelessness Scale, the Difficulties in Emotion Regulation Scale, and the Pain Coping Questionnaire. A two-step cluster analysis was performed to identify subgroups within the sample, followed by independent samples t-tests to assess psychological differences between clusters. Results. This study identified two clinical profiles among individuals with CP, distinguished by diagnostic delay, disease progression, and functional impact. Cluster 1 exhibited greater functional impairment, lower quality of life, and higher emotional distress (uncertainty, perceived burdensomeness, emotional dysregulation, and hopelessness). In contrast, Cluster 2 showed lower functional impairment, better quality of life, greater use of distraction strategies, and a higher meaning in life. Discussion. These findings suggest that both medical and psychological aspects appear to be associated with each other and may influence the perception, evolution and adaptation to CP. Full article

Background: Functional Neurological Disorder (FND) encompasses a spectrum of symptoms—including motor, cognitive, and seizure-like manifestations—that are not fully explained by structural neurological disease. Accumulating evidence suggests that comorbid psychiatric and somatic conditions significantly influence the clinical course, diagnostic complexity, and treatment response in FND. Objective: This study systematically explores psychiatric and medical comorbidities across major FND subtypes—Functional Cognitive Disorder (FCD), Functional Movement Disorder (FMD), and Psychogenic Non-Epileptic Seizures (PNES)—with an emphasis on subtype-specific patterns and shared vulnerabilities. Methods: We conducted a narrative review of the published literature, guided by systematic principles for transparency, covering both foundational and contemporary sources to examine comorbid conditions in patients with FCD, FMD, PNES, PPPD and general (mixed) FND populations. Relevant studies were identified through structured research and included based on methodological rigor and detailed reporting of comorbidities (PRISMA). Extracted data were organized by subtype and comorbidity type (psychiatric or medical/somatic). Results: Across all FND subtypes, high rates of psychiatric comorbidities were observed, particularly depression, anxiety, PTSD, and dissociative symptoms. FCD was predominantly associated with internalizing symptoms, affective misattribution, and heightened cognitive self-monitoring. FMD demonstrated strong links with trauma, emotional dysregulation, and personality vulnerabilities. PNES was characterized by the highest burden of psychiatric illness, with complex trauma histories and dissociation frequently reported. Somatic comorbidities—such as fibromyalgia, chronic pain, irritable bowel syndrome, and fatigue—were also prevalent across all subtypes, reflecting overlapping mechanisms involving interoception, central sensitization, and functional symptom migration. Conclusions: Comorbid psychiatric and medical conditions are integral to understanding the presentation and management of FND. Subtype-specific patterns underscore the need for individualized diagnostic and therapeutic approaches, while the shared biopsychosocial mechanisms suggest benefits of integrated care models across the FND spectrum. Full article

Burning mouth syndrome (BMS) and oral lichen planus (OLP) are two chronic oral diseases/disorders that continue to pose a challenge for conventional diagnosis and treatment. Both diseases do not occur in isolation but rather appear to reflect a broader interplay of psychological, neurological, endocrine, and immunological factors, i.e., complex disorders in interconnected biological and psychological systems. In BMS, patients often suffer from persistent burning sensations without visible lesions, which may be related to altered pain processing, emotional stress, and dysregulation in the brain regions responsible for interoception and perception. Although OLP is primarily characterised by immune-mediated mucosal damage, it often has significant psychological comorbidity, particularly in the erosive form. Common features such as cortisol imbalance, disturbed cytokine patterns, and high levels of anxiety and depression suggest that these conditions may be due to overlapping systemic disorders. It is no longer sufficient to focus only on the visible lesions or symptom relief. Understanding these diseases/disorders through a more comprehensive psychoneuroendocrine immune system (PNEI) opens up new opportunities for early intervention, improved diagnostics, and more personalised therapeutic strategies that go beyond treating symptoms. Ultimately, these diseases/disorders require a more integrated and patient-centred approach, where understanding the whole system is as important as treating its individual parts. Full article

Facial emotion recognition has become increasingly important in healthcare, where understanding delicate cues like pain, discomfort, or unconsciousness can support more timely and responsive care. Yet, recognizing facial expressions in real-world settings remains challenging due to varying lighting, facial occlusions, and hardware limitations in clinical environments. To address this, we propose TriViT-Lite, a lightweight yet powerful model that blends three complementary components: MobileNet, for capturing fine-grained local features efficiently; Vision Transformers (ViT), for modeling global facial patterns; and handcrafted texture descriptors, such as Local Binary Patterns (LBP) and Histograms of Oriented Gradients (HOG), for added robustness. These multi-scale features are brought together through a texture-aware cross-attention fusion mechanism that helps the model focus on the most relevant facial regions dynamically. TriViT-Lite is evaluated on both benchmark datasets (FER2013, AffectNet) and a custom healthcare-oriented dataset covering seven critical emotional states, including pain and unconsciousness. It achieves a competitive accuracy of 91.8% on FER2013 and of 87.5% on the custom dataset while maintaining real-time performance (~15 FPS) on resource-constrained edge devices. Our results show that TriViT-Lite offers a practical and accurate solution for real-time emotion recognition, particularly in healthcare settings. It strikes a balance between performance, interpretability, and efficiency, making it a strong candidate for machine-learning-driven pattern recognition in patient-monitoring applications. Full article

Background/Objectives: Patients with heart failure (HF) experience increased morbidity, limited daily activities, and diminished quality of life (QoL), thus relying on a family member, widely known as informal caregiver, for support. The objective of this study was to explore (a) QoL, anxiety, and depression; (b) factors associated with QoL; and (c) the impact of associated factors on QoL among HF caregivers. Materials and methods: Data collection was performed using the 36-Item Short Form Survey (SF-36), the Hospital Anxiety and Depression Scale (HADs), and the European Heart Failure Self-care Behavior Scale (EHFScBS). Also recorded were characteristics of caregivers and patients. Results: In the present study, 110 HF caregivers and the family members they provided care to were enrolled. The majority of caregivers were patients’ spouses (60%) and were female (71.8%). Within a QoL score range of 0–100, caregivers showed moderate to high levels in role-physical, role-emotional, emotional well-being, and pain (median: 75, 66.7, 64, and 67.5, respectively); moderate QoL levels in energy/fatigue, social functioning, and general health (median: 55, 56.3, and 62, respectively); and poor QoL levels in physical functioning (median: 18). Moreover, 64.5% of caregivers had anxiety and 41.8% had depression. Caregivers with HADs scores that indicate anxiety and depression had worse QoL (p = 0.001). No association was detected between caregivers’ QoL and patients’ HADs and self-care. Conclusions: QoL and anxiety/depression merit further research by clinicians, health systems, and policymakers so that evidence-based policies and interventional programs tailored to their needs can be implemented. Full article

Background/Objectives: Multiple sclerosis (MS) is a chronic neurodegenerative disorder mainly affecting young adults and can greatly impair quality of life (QoL). Among its often overlooked but significant symptoms are bowel dysfunctions (BD), such as constipation and fecal incontinence, which can impact physical, emotional, and social well-being, especially in younger patients. This study aims to investigate the impact of BD on the QoL in young adults diagnosed with relapsing-remitting MS (RRMS) and mild disability. Methods: This retrospective cross-sectional study examined the effect of BD on QoL in 110 young adults with RRMS and mild disability (EDSS ≤ 3.5). Bowel symptoms were assessed using the Wexner Incontinence and Constipation Scales, while QoL was measured with the MSQoL-54 questionnaire. Statistical analyses were performed to examine correlations between BD severity and QoL domains. Results: Our findings showed significant correlations between the severity of intestinal symptoms and different domains of QoL, like physical functioning, emotional well-being, and social functioning. Abdominal pain and liquid fecal incontinence were especially linked to lower mental and physical health scores. Subgroup analyses also indicated gender-specific vulnerabilities, with women showing distinct effects on social and emotional dimensions. Conclusion: BD represents an important burden on bowel dysfunctions for young people with MS, deeply impacting various dimensions of QoL. This underscores an urgent need for an integrated, multidisciplinary care model that tackles physical symptoms but also psychological and social challenges. A holistic clinical strategy is vital to improving the overall well-being of this population. Full article

Background/Objectives: Chronic musculoskeletal pain without a clearly identifiable medical cause is characterised by significant emotional distress and/or functional disability. Given the relatively limited research specifically addressing chronic primary musculoskeletal pain (CPMP), as defined in the latest revision of the International Classification of Diseases (ICD-11), the present study aimed to examine its psychopathological and sleep-related implications, and to explore whether pain intensity is associated with psychological distress and poor sleep quality. Methods: This observational study included 60 adult participants, comprising 30 patients diagnosed with CPMP and 30 healthy controls without any diagnosis. Participants completed the Numeric Pain Rating Scale (NPRS), the Symptom Checklist-90-R (SCL-90-R), and the Pittsburgh Sleep Quality Index (PSQI). Results: Patients with CPMP exhibited significantly higher levels of psychopathological symptomatology on the SCL-90-R and poorer sleep quality on the PSQI compared to controls (p < 0.05 for most dimensions). Greater pain intensity on the NPRS was strongly associated with psychological distress (e.g., GSI: r = 0.838, p < 0.01) and poor sleep quality (r = 0.785, p < 0.01). Hierarchical regression analyses revealed that pain intensity may play a meaningful role in both psychological distress and sleep quality (p < 0.05 across all models), even after statistically controlling for sex, age, and pain duration. Conclusions: These findings suggest that pain intensity is not only a key physical symptom, but also a relevant factor in understanding the broader psychological vulnerability in patients with CPMP. The present study contributes to a deeper understanding of the psychopathological and functional impact of CPMP and underscores the need for tailored psychological interventions to address the comorbid symptoms associated with this condition. Full article

The present study aimed to systematically review the anxiolytic and analgesic effects of gabapentin and pregabalin in domestic cats to assess the quality of using these medications for stress, fear, and anxiety management, and the treatment of both acute and chronic pain. The search was carried out between March and May 2025 using four databases: PubMed, Scopus, ScienceDirect, and Google Scholar. The keywords used were the combination of “pregabalin,” “gabapentin,” “analgesia,” “anxiety,” “stress”, and “cats”. Narrative reviews, as well as experimental and observational studies, were included. Experimental studies were classified as randomized controlled trials, controlled clinical trials, and prospective clinical trials, using the GRADE Pro GDP software (FP7-HEALTH.2010.3.1-1-two stage) to assess the certainty and confidence of the evidence. The initial search identified 57 manuscripts, of which 40 met the inclusion criteria. These studies focused on the management of stress, fear, and anxiety, as well as the control of acute and chronic pain in cats. Of these, 21 mention the use of gabapentin as an anxiolytic, while five report similar therapeutic effects of pregabalin. Regarding pain treatment, 12 papers and 2 papers support the use of gabapentin and pregabalin, respectively. This study confirms the validity of both drugs as therapeutic options for the management of stress, fear, and anxiety that impact the emotional welfare of cats. Furthermore, these drugs have been included in therapeutic guidelines for the control and treatment of acute and chronic pain in domestic cats. In conclusion, this systematic review supports the use of both drugs. Still, it highlights the need for more in-depth research and additional clinical trials to complement the existing evidence on the use of gabapentin and pregabalin. Full article

Fibromyalgia has unclear etiopathogenesis, no curative treatment, and a severe impact on the quality of life. Gratitude practices have been shown to enhance the quality of life in chronic diseases. This systematic review, performed by searching five electronic databases, following the PRISMA guidelines, is the first aiming to evaluate the impact of gratitude in fibromyalgia. Data from eligible studies was extracted and a narrative synthesis was performed. Six articles (four observational studies and two randomized clinical trials) were included. Higher levels of gratitude are associated with reduced symptom severity, an enhanced quality of life, improved well-being, and the improvement of pain-related outcomes in fibromyalgia patients. Gratitude is related to reduced stress, anxiety, and depression; better sleep patterns; and less functional impairment in FM patients. Higher levels of gratitude contribute to a better quality of life, general well-being, and higher functioning capacity in fibromyalgia patients. Based on the results gathered in this systematic review, we propose that gratitude should be investigated as a therapeutic adjuvant in the management of fibromyalgia. Full article