Search Results (175)

Background and Objectives: Chronic low back pain (CLBP) is a prevalent condition that impairs quality of life, functionality, and work productivity. While most acute episodes of back pain resolve, 4–25% become chronic due to factors such as high pain intensity, psychological distress, and maladaptive behaviors. Nonspecific CLBP is best understood through the biopsychosocial model, encompassing biological, psychological, and social influences, including kinesiophobia. Management relies on physical activity, pain education, and psychological interventions, with therapist knowledge and attitudes affecting outcomes. This study aimed to assess the prevalence of CLBP among healthcare workers, examine their knowledge of pain neurophysiology, evaluate kinesiophobia, and explore how personal experience with CLBP influences their beliefs, attitudes, and interactions with patients. Materials and Methods: A cross-sectional observational study was conducted from January to May 2025 among healthcare professionals. A total of 50 participants completed an online questionnaire, of which 42 were valid and included in the analysis. The questionnaire collected demographic and professional data, determined the presence of CLBP, and included three standardized instruments: the Revised Neurophysiology of Pain Questionnaire (rNPQ) to assess knowledge of pain mechanisms, the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) to evaluate beliefs about pain and disability, and the Tampa Scale of Kinesiophobia (TSK-11) to measure fear of movement. Data were analyzed using SPSS and Microsoft Excel. Results: Among the 42 participants, 11 demonstrated low, 28 moderate, and 3 high knowledge of pain neurophysiology (rNPQ), with a mean score of 5.66. On the HC-PAIRS, the majority (30 participants) scored above 60, indicating beliefs that pain leads to disability, while 12 scored below 60, reflecting a biopsychosocial perspective; gender did not significantly affect HC-PAIRS scores (p = 0.213). As for kinesiophobia (TSK-11), 24 participants had low, 17 moderate, and 1 clinically significant fear of movement. Correlation analysis revealed that younger participants had higher rNPQ scores (r = −0.358, p = 0.020) and lower TSK-11 scores (r = −0.389, p = 0.011). TSK-11 scores increased with age (r = 0.432, p = 0.004), while HC-PAIRS scores showed no significant correlations. Conclusions: Healthcare professionals, particularly physiotherapists, show gaps in knowledge of pain neurophysiology and a tendency toward biomedical beliefs regarding chronic low back pain. This cross-sectional study indicates that a greater understanding of pain mechanisms is associated with lower kinesiophobia, emphasizing the importance of education. Integrating the biopsychosocial model into undergraduate and continuing professional training, through interdisciplinary and practical modules, may improve knowledge, reduce maladaptive fear-avoidance behaviors, and enhance patient care. Future studies should include larger, more diverse samples and assess the long-term impact of educational interventions on clinical practice. Full article

Background/Objective: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have received widespread attention as effective obesity treatments. However, limited research has examined the perspectives of patients contemplating GLP-1RAs. This study explored perceptions, motivations, and barriers among individuals considering GLP-1RA therapy for obesity treatment, with the goal of informing patient-centered care and enhancing clinician engagement. Methods: Adults completed surveys and interviews between June and November 2025. In this pragmatic mixed-methods study, both survey and interview questions explored perceived benefits, barriers, and decision-making processes. Qualitative data, describing themes based on the Health Belief Model, were analyzed using Dedoose (version 9.0.107), and quantitative data were analyzed using SAS (version 9.4). Participant characteristics included marital status, income, educational attainment, employment status, insurance status, age, race/ethnicity, and sex. Anticipated length on GLP-1RA medication and selected self-reported health conditions (depression, anxiety, hypertension, heart disease, back pain, joint pain), reported physical activity level, and perceived weight loss competency were also recorded. Results: Among the 31 non-diabetic participants who were considering GLP-1RA medication for weight loss, cost emerged as the most significant barrier. Life course events, particularly (peri)menopause among women over 44, were commonly cited as contributors to weight gain. Participants expressed uncertainty about eligibility, long-term safety, and treatment expectations. Communication gaps were evident, as few participants initiated discussions and clinician outreach was rare, reflecting limited awareness and discomfort around the topic. Conclusions: Findings highlight that individuals considering GLP-1RA therapy face multifaceted emotional, financial, and informational barriers. Proactive, empathetic clinician engagement, through validation of prior efforts, clear communication of risks and benefits, and correction of misconceptions, can support informed decision-making and align treatment with patient goals. Full article

This essay confronts a classic tension: Christian tradition has long linked death in the world to human sin, yet evolutionary science reveals eons of predation, pain, and extinction preceding the emergence of Homo sapiens. In this essay, it is asked whether and how this history can be reconciled with belief in a good creation by the God who is love. After situating the stakes of this question with regard to evangelization, I examine Jesuit physicist Richard Pendergast’s ambitious proposal that fallen angels reshaped the material order and thereby seeded natural evil throughout evolutionary time. I set this account in critical conversation with major figures of the Christian tradition, including Augustine, but especially Joseph Ratzinger (Benedict XVI) and Thomas Aquinas, who—while upholding the fall and the need for redemption—locate suffering and death within natural order of creation and compatible with the divine goodness rather than as anomalies. It will be seen that Ratzinger, for his part, proposes a way to preach and live a “creation and evolution” synthesis in which the cross and resurrection illuminate, rather than erase, the hard facts of biological history. The essay concludes by assessing the metaphysical feasibility, scientific plausibility, and theological fittingness of attributing foundational and large-scale natural processes to angelic causation, noting that it risks dualism and the eclipse of creation’s fundamental goodness. Full article

Background and Objectives: Subacromial pain syndrome (SAPS) is one of the most common musculoskeletal problems affecting the shoulder joint. In this study, we aimed to investigate the effectiveness of a rehabilitation program targeting humeral head depressor muscles on symptoms in individuals with SAPS. Materials and Methods: Participants were sequentially assigned to study and control groups in a quasi-randomized design. While the control group received standard physical therapy and rehabilitation, the study group underwent a combined progressive exercise program, including humeral head depressor strengthening, peri-articular muscle exercises, scapular stabilization, and proprioceptive training. Acromio–humeral distance (AHD) and tendon thickness measurements were evaluated via ultrasonography (USG), while pain intensity, upper-extremity disability, and kinesiophobia were measured using the VAS and McGill Pain Questionnaire, DASH-T, and the Fear Avoidance Beliefs Questionnaire, respectively. Results: Both the study and control groups showed statistically significant increments in AHD compared to the baseline. The first and final measurements changed from 7.92 mm to 10.54 mm and from 7.72 mm to 8.41 mm, respectively. However, the increase in AHD was greater in the study group relative to the control group, and the value was statistically significant. The study group showed significant improvements in pain and disability. Kinesiophobia levels, on the other hand, decreased in both groups, but a greater decrease was observed in the study group. Conclusions: In this study, both the study and control groups showed an increase in AHD, but the combined exercise program targeting humeral head depressor muscles resulted in a greater improvement. Reduced tendon thickness indicated the eased motion of the rotator cuff, supporting the improvements in pain and disability. The program had a positive impact on psychosocial parameters, including pain-related kinesiophobia. Given the limited literature on the effects of such exercises on AHD and tendon thickness, this study provides an original contribution. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT07228455. Full article

Background and Objectives: Breast cancer is the most common cancer in women, with approximately 80% being oestrogen receptor positive, necessitating adjuvant endocrine therapy (AET) to reduce recurrence. Treatment adherence is crucial, yet 10–50% of patients take incorrect doses or discontinue therapy, which is associated with a 20% increase in mortality. AET may also impact bone health. This study aimed to explore patients’ beliefs about endocrine treatment, investigate how perceptions of medication risk and benefit affect adherence, and assess changes in bone mineral density (BMD) during therapy. Materials and Methods: A cross-sectional mixed-method study was conducted. One hundred patients diagnosed with oestrogen receptor-positive breast cancer in 2020 were sent the Beliefs about Medicines Questionnaire–Adjuvant Endocrine Therapy (BMQ-AET) and 101 semi-structured telephone interviews were completed. Initial and most recent Dual-Energy X-ray Absorptiometry (DEXA) scans were compared to assess changes in BMD. Results: The questionnaire response rate was 55% (n = 55). Forty-nine patients returned the postal paper survey and six patients responded via QR code. One hundred and one patients participated in semi-structured telephone interviews. Of the total cohort, 91.7% were adherent to AET, while 13 patients (8.3%) were non-adherent. Non-adherent patients had significantly lower BMQ-AET Necessity scores (mean 12.08 vs. 19.22; median 12 vs. 20; p < 0.001) and higher Concerns scores (mean 17 vs. 13.46; Median 17 vs. 13; p = 0.002). The most common reasons for non-adherence were joint pain and reduced quality of life (58%), highlighting a need for additional support in managing side effects. Among the participants with suitable DEXA data, the majority (54.2%) demonstrated an increase in BMD over time. Conclusions: This study demonstrates high adherence to AET, with non-adherent patients showing lower perceived necessity and greater concern about treatment. These findings emphasise the importance of addressing patient beliefs to enhance adherence. The observed improvements in BMD suggest that proactive bone health management, alongside AET, may mitigate expected declines, challenging conventional assumptions regarding therapy-related bone loss. Full article

Background/Objectives: Chronic non-malignant pain (CNMP) affects 46.4% of adults in Saudi Arabia and often requires interdisciplinary care, including mental health services. Despite this need, mental health integration remains limited. This study explored healthcare providers’ perceptions of integrating mental health services into CNMP management and identified barriers and facilitators to interdisciplinary collaboration. Methods: A cross-sectional survey was conducted among 114 healthcare providers across Saudi Arabia. Using the Theoretical Domains Framework (TDF), domains such as knowledge, skills, beliefs about capabilities and consequences, reinforcement, and social influences were assessed. Data were analyzed using descriptive statistics, correlation analyses, and multiple regression. Results: Positive perceptions of mental health integration were significantly associated with beliefs about capabilities (r = 0.31, p = 0.001) and beliefs about consequences (r = 0.40, p < 0.001), as well as skills (r = 0.30, p = 0.001) and reinforcement (r = 0.26, p = 0.005). Multiple regression confirmed beliefs about capabilities (B = 0.208, p = 0.001) and consequences (B = 0.237, p < 0.001) as independent predictors, explaining 31.9% of the variance in perceptions (R² = 0.319, adjusted R² = 0.285). Emotional responses, such as stress, were potential barriers but did not independently predict perceptions. Systemic challenges included limited referral pathways and insufficient mental health resources. Conclusion: Confidence in professional abilities and recognition of the benefits of collaboration are key drivers of positive perceptions toward mental health integration in CNMP care. Interventions that enhance provider confidence, emphasize interdisciplinary benefits, and strengthen organizational support may improve engagement with mental healthcare services in Saudi Arabia. Full article

In this article, we explain how Kant upends the terms of the debate concerning the relationship between God’s existence and an objective morality by looking at his moral-teleological argument for God’s existence in the third Critique. We explain Kant’s rejection of external sources of moral normativity and his method of grounding moral authority in the normativity of practical reason. We then turn to Kant’s argument justifying a practical belief in God as the moral author of nature. Kant’s claims about how we must conceptualize organisms teleologically and, as a result, how reason seeks an unconditioned end of nature, brings together our moral purpose with a conception of nature as an organized whole. Since our teleological concepts of organisms seem to require that human beings serve as the final, unconditioned end of nature, but morality and nature might be incompatible and divergent, we must also believe in a moral author of nature. This belief guards against demoralization and creates a unified view of the human moral agent and the world she inhabits, which Kant thinks of as indispensable for our practical lives. Kant notoriously blurs the lines between theology and ethics in nonstandard ways. Although he rejects many traditional approaches to grounding ethics in a conception of divine commands or eternal law, he still devotes a considerable amount of time to discussing the role of religion as a bulwark of the moral life. The goal of this paper is to defend Kant’s relevance to a discussion of the relationship between an objective ethics and the existence of God; his contribution deserves our notice precisely for the ways in which it promises to shift the terms of the contemporary debate and complicate possible answers to the question of whether there can be an objective morality without God. In contemporary philosophical literature, Kant’s argument contending that we must hope in God from a practical point of view on pain of irrationality of acting from duty has enjoyed substantial discussion. Here, however, we focus on a lesser-known suite of arguments that in order to so much as cognize ourselves and other species as the sorts of natural beings they are, we must believe in a supersensible moral author of these natures. This set of arguments ultimately dovetail with the more well-known argument for theistic hope and operate in much the same way. But they touch on facets of Kant’s whole philosophical system, such as his account of teleological judgment and the unity and final end of all of nature. Our goal is to explicate these arguments and illuminate their relevance of these Kantian arguments to the debate about the relevance of God to objective morality. We will argue that while an objective ethics is possible without God due to the active role of practical reason in rational agents, belief in God’s existence strengthens the claims of morality, both for psychological reasons but also by providing a more unified conception of moral and natural reality. Full article

Background/Objectives: Chronic low back pain is the leading global cause of disability, with a growing prevalence and socioeconomic burden. Despite strong evidence supporting exercise therapy (ET) as a primary treatment, adherence rates remain low, compromising outcomes and increasing healthcare costs. Research on contributing factors to adherence to ET in non-specific chronic low back pain (nsCLBP) is limited. This systematic review aimed to reconceptualise contributors to adherence, using a conceptual framework to explore their interrelations and complexity by integrating quantitative and qualitative research. Methods: PubMed, Web of Science and Scopus were searched, followed by a two-phase screening process. Risk of Bias (RoB), certainty assessment and level of evidence were assessed independently. Results: Eight qualitative and eleven quantitative studies were included, the latter divided into nine RCTs and two cohort studies. Overall, eight included studies showed low RoB, seven showed some concerns, and four presented high RoB. Synthesis identified internal, external, and intervention-related contributing factors. These factors were presented in a conceptual framework figure, highlighting that adherence should not be viewed as a binary concept but rather as a dynamic behaviour shaped by interrelated factors. Moderate-certainty evidence supports the impact of psychosocial factors, healthcare professional (HCP) characteristics, environmental and time-related factors, program design, progression, home-exercise program (HEP), modalities, and follow-up. Low-to-moderate-certainty evidence suggests beliefs, patient-related characteristics, and treatment setting also impact adherence. Low-certainty evidence indicates that feedback, symptoms and impairments, and confidence possibly impact adherence. Conclusions: This systematic review highlights the complex, context-dependent interplay of factors impacting adherence to ET in individuals with nsCLBP. Overall, these findings underscore the need for personalised, context-sensitive interventions that address the broad spectrum of factors, while future research should focus on validated adherence assessment tools. Full article

Objectives: The central nervous system plays a fundamental role in chronic pain; however, its behavior in this condition remains unclear, especially when associated with interventions such as kinesiotaping (KT). This study aimed to analyze the effects of KT on the somatosensory cortex of women with chronic low back pain. Methods: This case series involved 15 women with chronic low back pain. Participants underwent a progressive-tension KT protocol for 8 weeks, and electroencephalogram recordings were performed in two positions, namely sitting and standing while load bearing (10% of body weight), in the first and eighth weeks. The following instruments were employed: Oswestry lumbar disability index, fear avoidance beliefs questionnaire, and the numerical pain intensity scale. Results: All participants showed significant pain improvement and a reduction in Oswestry disability index scores from moderate to minimal. Additionally, activity in the alpha band within the somatosensory cortex and insula (central region—represented by the electrode Cz) decreased. This was confirmed by reduced power spectral density, indicating diminished cortical activity in these regions. Conclusions: KT positively affects women with chronic low back pain, providing pain reduction and improved functional capacity, as indicated by the fear avoidance beliefs questionnaire and numerical pain intensity scale. Moreover, KT reduces cortical activity in the somatosensory cortex, which is related to the progression of painful sensations, described above after the intervention. Full article

Background: Cancer-related pain is a common and distressing symptom among patients with cancer. Although acupuncture is widely used and supported by growing evidence, its real-world use and related patient attitudes remain underexplored in South Korea. This study aimed to investigate patterns of acupuncture use and identify factors influencing its use among Korean cancer patients experiencing pain. Methods: A cross-sectional survey was conducted from October 2023 to May 2024 at six Korean medicine hospitals. A total of 201 cancer patients with pain completed a questionnaire assessing acupuncture use, pain severity and interference, and beliefs using a modified version of the ABCAM (Attitudes and Beliefs about Complementary and Alternative Medicine) instrument. Treatment concerns, logistical barriers, and social norms were analyzed. Results: Of the 201 participants, 80.6% reported using acupuncture for cancer-related pain. Pain severity was the only significant predictor of acupuncture use (OR = 1.53, 95% CI: 1.10–2.12, p = 0.01). Acupuncture users reported fewer concerns about safety and side effects, fewer logistical barriers, and stronger encouragement from family, healthcare providers, and peers. Conclusions: This is the first study to explore real-world use of acupuncture for cancer pain in South Korea. Greater pain severity, perceived safety, ease of access, and social support were associated with higher acupuncture use. These findings suggest that improved patient education and integration of acupuncture into cancer care may enhance pain management for Korean patients. Full article

Background and Objectives: The Nordic hamstring exercise (NHE) effectively strengthens the hamstrings, reduces the risk of hamstring strain, and induces fatigue in the muscles; thus, post-NHE recovery strategies should be optimized. Foam rolling (FR) is a widely used method, with the belief that it can speed up recovery. Thus, this study investigated the acute and 48-h effects of FR following the NHE on muscle stiffness, pain pressure threshold (PPT), flexibility, countermovement jump (CmJ) height, and maximal voluntary isometric contraction (MVIC). Materials and Methods: Thirty-two active males were randomly assigned to either an FR group (n = 16) or a passive recovery (PR, n = 16) group. Measurements were taken at three time points: pre-test, post-test_0h, and post-test_48h. Participants performed the NHE (3 sets × 10 reps) before the recovery interventions. Variables assessed included muscle stiffness (MyotonPro), flexibility (sit and reach), PPT (algometer), jump performance (force platform), and MVIC peak torque (dynamometer). Results: FR significantly improved acute flexibility (12.7%, p < 0.001) following the NHE and prevented flexibility loss at 48 h, compared to the PR group. However, FR showed no significant advantages over PR in terms of muscle stiffness, PPT, CmJ, or MVIC, both acutely and at 48 h (p > 0.05). Conclusions: FR is an effective acute recovery strategy for improving flexibility after the NHE but offers limited effects for muscle stiffness, PPT, and other functional muscle parameters, both acutely and at 48 h. Further research should explore the long-term effects and efficacy of FR across diverse populations and recovery scenarios. Full article

Unregulated herbal products marketed via digital platforms present escalating risks to consumer safety and regulatory effectiveness worldwide. This study positions the case of Jindamanee herbal powder—a banned substance under Thai law—as a lens through which to examine broader challenges in digital health governance. Drawing on a dataset of 1546 product listings across major platforms (Facebook, TikTok, Shopee, and Lazada), we applied Latent Dirichlet Allocation (LDA) to identify prevailing promotional themes and compliance gaps. Despite explicit platform policies, 87.6% of listings appeared on Facebook. Medical claims, particularly for pain relief, featured in 77.6% of posts, while only 18.4% included any risk disclosure. These findings suggest a systematic exploitation of regulatory blind spots and consumer health anxieties, facilitated by templated cross-platform messaging. Anchored in Information Manipulation Theory and the Health Belief Model, the analysis offers theoretical insight into how misinformation is structured and sustained within digital commerce ecosystems. The Thai case highlights urgent implications for platform accountability, policy harmonization, and the design of algorithmic surveillance systems in global health product regulation. Full article

Background/Objectives: The pain associated with invasive procedures is one of the most common experiences in the pediatric population. Its management remains insufficient due to gaps in healthcare training and knowledge. The aim of this study was to analyze the attitudes, beliefs, care practices, and training of healthcare professionals in relation to pediatric pain, through the development and application of the questionnaire ‘Humanisation of Pediatric Care in Pain Management with a Non-Pharmacological Approach (HUPEDCARE-Q)’. Methods: A cross-sectional, observational, and descriptive study with a quantitative approach was conducted to validate a questionnaire. The process was carried out in three phases: (1) design and initial development of the instrument; (2) evaluation of content validity through expert judgment, using the Content Validity Coefficient (CVC); (3) administration of the questionnaire to a large sample of healthcare professionals to assess its internal consistency and psychometric structure. Results: The evaluation involved five experts, and the items were assessed using the Content Validity Coefficient (CVC), with the overall CVC of the questionnaire exceeding 0.80. The average item scores given by the experts ranged from 0.88 to 0.95, indicating a high level of agreement in their evaluations. The results showed statistically significant positive correlations among most items (p < 0.001), indicating adequate internal consistency. Conclusions: The content validation and pilot study confirmed the theoretical relevance and appropriateness of the HUPEDCARE-Q questionnaire items in the Spanish context. The results support its usefulness as a valid and reliable tool to identify attitudes, beliefs, knowledge, and training needs in the humanized management of pediatric pain. Full article

Chronic musculoskeletal pain negatively affects patients’ quality of life, and pain perceptions may significantly influence rehabilitation outcomes. This study investigated the relationships among pain intensity, pain perceptions, and kinesiophobia in individuals with chronic musculoskeletal pain. No previous studies have examined these variables in combination. A cross-sectional observational study was conducted with 37 participants with non-specific chronic musculoskeletal pain for at least 6 months, affecting the neck (n = 8), lower back (n = 18), upper limbs (n = 5), lower limbs (n = 5), or shoulder (n = 1). The following validated tools were used: (a) Pain Beliefs and Perceptions Inventory (PBPI), (b) the Tampa Scale for Kinesiophobia (TSK), and (c) the Short-Form McGill Pain Questionnaire (SF-MPQ). Spearman r correlation analyses were performed. Total kinesiophobia scores were positively correlated with (a) total pain intensity (McGill score) (r = 0.37, p = 0.022), (b) present pain intensity (PPI) (r = 0.52, p = 0.001), (c) pain duration (r = 0.51, p = 0.001), (d) the “mystery” factor of pain perception (r = 0.41, p = 0.013), and (e) the Visual Analogue Scale (VAS) (r = 0.42, p = 0.009). The total pain perception scores were positively associated with the “fear of injury” factor of kinesiophobia (r = 0.36, p = 0.028). The McGill pain scores were strongly correlated with both PPI (r = 0.63, p = 0.001) and VAS (r = 0.51, p = 0.001). There is a significant relationship between pain perception and kinesiophobia levels in patients with chronic musculoskeletal pain. Limitations of the study include a small and heterogeneous sample regarding pain localization. Further research is required using larger, more homogeneous populations to confirm the present findings. Full article

Aim: To explore the experiences, beliefs, and values of patients who participated in a two-arm randomized clinical trial assessing a nurse-led intervention program for chronic pain self-management, which demonstrated positive effects on pain reduction, depression, and anxiety, and on health-related quality of life 24 months after completion of the program. Design: Descriptive phenomenological qualitative study. Methods: Patients were recruited via telephone, informed about the study, and invited to participate in an individual interview at a place of their choice (hospital or home). All interviews were audiotaped, and an inductive thematic analysis was performed. Results: Seven interviews were carried out between both groups. Six emerging categories were found: effective relationship with the healthcare system, learning to live with pain, family and social support, behaviors regarding pain, resources for self-management, and concomitant determinants. Conclusions: Patients report key aspects that help us to understand the impact of this type of nurse-led group intervention: the intrinsic therapeutic effect of participating in the program itself, the ability to learn to live with pain, the importance of family and social support, the modification of pain-related behaviors, and the identification of resources for self-care. The findings highlight the need for gender-sensitive, individualized care approaches to chronic pain, addressing stigma and social context. Expanding community-based programs and supporting caregivers is essential, as is further research into gender roles, family dynamics, and work-related factors. Full article