Search Results (127)

Infertility is a complex health issue that extends beyond biological mechanisms, encompassing significant psychological, relational, and social aspects. Advances in assisted reproductive technologies have improved the chances of conception, yet many couples discontinue treatment due to stress, stigma, and reduced quality of life. This narrative review explores the role of rehabilitation as a complementary approach to conventional fertility care, highlighting psychological, physical, and integrated interventions. Psychological rehabilitation strategies, such as cognitive behavioral therapy, mindfulness-based interventions, and couple-focused counseling, have been shown to reduce anxiety and depression, improve coping, and, in some cases, support better adherence to fertility treatments. Physical rehabilitation approaches, including pelvic floor muscle training, structured exercise for women with polycystic ovary syndrome, lifestyle and fitness interventions for men, yoga, and sexual rehabilitation, contribute to reproductive health, reduce pain, and enhance intimacy. Integrated models that combine psychological and physical components show the greatest promise, as they address the interaction between stress, physical function, and reproductive outcomes. Overall, the evidence suggests that infertility care should not focus solely on achieving conception. Rehabilitation offers opportunities to strengthen emotional resilience, improve sexual health, and support relationship stability, ensuring that patients benefit not only medically but also in terms of long-term well-being and quality of life. Full article

Chronic pain is the leading cause of disability worldwide and frequently co-occurs with mild traumatic brain injury among Veterans (mTBI + CP), creating complex treatment challenges and a need for novel, non-pharmacological interventions. This study evaluated a pilot intervention combining intermittent theta burst stimulation (iTBS), a neuromodulatory approach, with the evidence-based LoveYourBrain Yoga program to enhance rehabilitation outcomes. In a six-week open-label trial, ten Veterans with mTBI + CP received weekly iTBS followed by yoga sessions. Pilot quantitative outcomes included quality of life (Traumatic Brain Injury Quality of Life [TBI-QoL]) and functional ability (Mayo Portland Adaptability Inventory-4 [MPAI-4]), assessed pre- and post-intervention, alongside qualitative semi-structured interviews and interdisciplinary clinical notes. Significant improvements were observed in TBI-QoL Fatigue (p = 0.021) and MPAI-4 Grief and Loss (p = 0.016), with clinically meaningful but non-significant gains in Ability and Adjustment. Qualitative findings revealed improved pain management and enhanced self-management, with participants describing better emotional regulation, more effective coping strategies, and stronger social connections. Some benefits were more evident in qualitative data than in standardized measures. These pilot findings suggest that combining iTBS with mind–body therapy may provide complementary tools for pain management and functional recovery in Veterans with mTBI + CP, supporting further investigation of integrated neuromodulation and behavioral interventions. Full article

Objectives: Fear of falling (FoF) is a common psychological phenomenon in later life and is often accompanied by avoidance behavior and activity restriction. Although FoF is associated with anxiety, depressive symptoms, reduced self-efficacy, and fear of loss of autonomy, older adults with FoF may differ substantially in the configuration of these characteristics. The present study aimed to identify data-derived profiles of older adults based on FoF, avoidance behavior, self-efficacy, and fear of loss of autonomy, and to examine profile-specific psychological predictors of FoF and avoidance behavior. Methods: The main analytical sample included 217 older adults aged 60–97 years (M = 76.45, SD = 10.14) with Mini-Mental State Examination scores of 20 or higher. Latent profile analysis was conducted using FoF, avoidance behavior, self-efficacy, and fear of loss of autonomy. Anxiety components, depressive symptoms, coping strategies, pain catastrophizing, and loneliness-related indicators were examined in class-specific regression models. The stability of the class solution was tested across different MMSE cut-off scores. Between-class comparisons were conducted for functional, fall-related, socio-demographic, and psychological indicators. Results: A three-class solution was selected and interpreted as adaptive, vulnerable, and maladaptive profiles. The profile structure remained relatively consistent across MMSE cut-off scores, including in the broader sample with MMSE ≥ 15. The classes did not differ significantly in postural balance or number of falls, suggesting that the profiles could not be fully explained by objective fall-risk indicators. Significant between-class differences were found for age, daily pain level, and state social defense. Class-specific regression models suggested that psychological variables associated with FoF and avoidance behavior differed across profiles. Pain appraisal and emotion-related coping were more relevant in the adaptive profile, phobic anxiety and anxious appraisal of future events in the vulnerable profile, and anxiety-related, depressive, interpersonal, and coping-related factors in the maladaptive profile. All reported associations remained significant after false discovery rate correction. Conclusions: FoF and avoidance behavior are related but not identical phenomena and vary across data-derived psychological profiles. A profile-oriented approach may provide a more differentiated understanding of activity restriction in older adults and help identify profile-specific targets for psychological support. Full article

Background and Objectives: Chronic neck pain is a prevalent condition linked to functional disability and maladaptive pain-related behaviors. Although the physical and psychosocial impairments have been extensively studied in the literature, the factors related to cognitive impairments are not fully understood. This study aimed to examine the physical, psychosocial, and cognitive impairments associated with chronic neck pain and examine the variables associated with cognitive performance in this population. Materials and Methods: This cross-sectional study included 87 individuals with chronic neck pain. Pain sensitivity, neck disability, physical capacity, cervical muscle strength, pain catastrophizing, kinesiophobia, and self-reported central sensitization were assessed in all participants. Within the scope of the neuropsychological assessment, global cognition, processing speed, attention, and executive functioning were evaluated. The relationship between physical, psychosocial, and cognitive impairments was assessed using Spearman correlation. Additionally, a multiple linear regression analysis was performed to assess the extent to which the independent variables were associated with cognitive performance. Results: Global cognition was moderately correlated with pain intensity (r = −0.427, p < 0.001) and pain catastrophizing (r = −0.414, p < 0.001). Difficulties in response inhibition were moderately related to age (r = 0.440, p < 0.001). Cervical muscle strength (r = 0.384–0.233) and physical capacity (r = 0.332) were also weakly correlated with global cognition (p < 0.05). Age exhibited the strongest relationship with global cognition (β = −0.332, p < 0.001), followed by pain intensity (β = −0.291, p = 0.004) and pain sensitivity (β = 0.253, p = 0.011), with an explained variance of 30.8%. Additionally, age showed the strongest association with difficulties in processing speed (β = 0.448, p < 0.001), followed by kinesiophobia (β = 0.325, p = 0.001) and neck disability (β = 0.262, p = 0.030), with an explained variance of 34.2%. Conclusions: These findings suggest that increased nociceptive sensitization and deficits in physical health may be associated with maladaptive pain-related coping strategies in individuals with chronic neck pain. Furthermore, cognitive impairments in these individuals may reflect a multidimensional association of demographic, physical, psychosocial, and sensorial mechanisms. Full article

Background/Objectives: Sickle cell disease (SCD) is the most prevalent inherited pediatric hematologic disease. Pain is the most common complaint and primary reason for emergency care. Effective coping is critical to improved quality of life for individuals with SCD and other chronic illnesses. Hope, engendered by provision of comprehensive care, may explain the positive impact of effective coping and improved health outcomes. The relevance of effective coping skills and hope’s impact on repeated hospitalizations and/or length of hospitalization stay (LOS) among adolescents with SCD is considered. A regional, comprehensive pediatric sickle cell center (RCPSCC) provided the services. Methods: Patients with SCD, ages 13 through 21 years seen in a university RCPSCC (URCPCC-SCD), completed surveys: a general scale providing a broad range of positive and maladaptive coping-related issues, and KIDCOPE, a standardized scale measuring pediatric coping strategies. Medical records were reviewed for frequency of hospitalization and length of stay (LOS) for the eight months before study entry. Results: Thirty-four URCPCC-SCD outpatients, mean/median age of 16 years, entered the study, and data were analyzed for 33. All reported some sense of future hopefulness, and almost half reported feeling “tense or wound up” most of the time. Use of avoidant or negative coping strategies in response to daily stress correlated positively with increased LOS. Conclusions: Youths with SCD require effective coping strategies to improve self-efficacy and related hope for brighter futures. Individualized, comprehensive treatment and support to families and individuals at risk for sickle cell crisis are uniquely offered in a URCPCC-SCD. Their contributions to service delivery and clinical outcome are expected to enhance hope, mitigate prolonged hospitalizations, and improve adherence to treatment (N = 268). Full article

Background/Objectives: With an increasing number of older adults remaining physically active into later life, there is a growing need to understand how they manage pain and stress without relying on pharmacological treatment. Although regular physical activity supports functional independence and psychological resilience, many active older adults still experience fluctuating pain or stress. However, they often prefer non-pharmacological strategies and avoid analgesics, even when experiencing pain. Yoga interventions are widely used to address both physical and psychological components of health across diverse populations. Methods: Twenty-three adults aged ≥65 years participated in a once-weekly, 60 min yoga program. Pain intensity (VAS), pain vigilance and passive awareness (PVAQ), coping strategies (CSQ), and depression, anxiety, and stress (DASS-21) were assessed pre- and post-intervention. Repeated-measures ANOVA and correlational analyses were conducted. Exploratory moderation analyses examined whether individual characteristics (physical activity, age, and yoga experience) influenced associations between changes in pain-related variables. Results: After participation in a 7-week yoga program, significant differences were observed: perceived stress decreased, and passive pain awareness increased. No significant changes occurred in pain intensity, fear, depression (although a decrease was observed), or coping strategies, although participants predominantly used adaptive coping at both time points. Moderation analyses showed that physical activity buffered the association between increased passive pain awareness and heightened pain, whereas age and prior yoga experience strengthened this association. Conclusions: Even in physically active older adults, yoga participation was associated with changes in passive pain awareness and reduced stress. However, increases in passive pain awareness may differentially influence pain depending on age, physical activity level, and previous yoga experience. Full article

Tension-type headache (TTH) is the most prevalent primary headache disorder worldwide, contributing substantially to individual disability and global socioeconomic burden. Despite its high prevalence, TTH remains clinically heterogeneous, with episodic and chronic forms influenced by the dynamic interplay of peripheral, central, psychosocial, and lifestyle-related mechanisms. Peripheral musculoskeletal factors, including craniocervical muscle alterations and myofascial trigger points, interact with central sensitization processes, while psychosocial stressors, coping strategies, and lifestyle habits such as sleep and physical activity modulate pain perception and chronification risk. Current approaches often address these domains in isolation, limiting therapeutic effectiveness and the understanding of interindividual variability. This narrative review critically synthesizes evidence on the multifactorial determinants of TTH, providing an integrative conceptual framework. We systematically searched PubMed, Scopus, and Web of Science for articles published between 2010 and 2025, including conceptually or methodologically foundational studies outside this range. Relevant studies were selected based on predefined inclusion criteria and synthesized narratively to highlight key mechanisms and contributing factors. The proposed model emphasizes multidimensional assessment, incorporating peripheral musculoskeletal evaluation, central pain modulation, psychosocial profiling, and lifestyle factors, thereby providing a conceptual basis for future personalized management approaches. Recognizing TTH as a dynamic, multidimensional condition may inform clinical assessment and patient-centered interventions, while also highlighting key gaps for future longitudinal and multimodal research aimed at validating the framework and improving individualized therapeutic strategies. The evidence presented is primarily narrative and observational, and clinical applicability should be confirmed in future studies. Full article

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent urological disorder characterized by persistent pelvic pain, urinary symptoms, and significant impact on quality of life. In addition to its clinical symptoms, CP/CPPS is frequently associated with psychiatric comorbidities, such as anxiety and depression, indicating complex neurobiological mechanisms. This review explores the mechanisms linking CP/CPPS with affective disorders, emphasizing central nervous system alterations, dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, and neuroimmune interactions. Evidence in-dicates that central sensitization, microglial and astrocytic activation, and elevated proinflammatory cytokines (IL-1β, IL-6, TNF-α) contribute to maladaptive painemotion network interactions. Additionally, dysregulation of hormones and neurotransmitters may exacerbate both pain perception and mood disorders. Psychosocial factors, including stress, coping strategies, and cognitive-emotional processes, further modulate symptom severity and treatment outcomes, highlighting the importance of a biopsychosocial approach. Gaining a deeper understanding of the neurobiological and psychosocial mechanisms behind anxiety and depression in CP/CPPS can lead to more effective, multidimensional management strategies and enhance patient-centered care. Full article

Background and Objectives: Psychological resilience is increasingly recognized as a determinant of how patients respond to surgical stress, yet its role in perioperative medicine remains poorly defined. This narrative review aims to synthesize current evidence on resilience in surgical populations from a psychobiological perspective, spanning conceptual models, measurement approaches, clinical correlates, biological mechanisms, and intervention strategies. Materials and Methods: This narrative review was conducted to examine psychological resilience in adult surgical populations from an integrated psychobiological and perioperative perspective. A structured literature search was performed in December 2026 using PubMed, Scopus, and PsycInfo, combining resilience-related constructs with surgical, perioperative, biological, and clinical outcome keywords. Eligible publications included observational, longitudinal, interventional, translational, and conceptually relevant studies addressing resilience in adult surgical settings. Evidence was synthesized qualitatively across predefined domains, including conceptualization and measurement of resilience, associations with perioperative outcomes, neuroendocrine and inflammatory mechanisms, and resilience-modulating interventions within perioperative and Enhanced Recovery After Surgery (ERAS) frameworks. Results: Contemporary models conceptualize resilience as a dynamic, context-dependent process supported by interacting psychological, biological, and social factors. In surgical cohorts, higher resilience is consistently associated with better patient-reported outcomes, including quality of life, pain control, and emotional adjustment, and in some studies with survival and functional recovery. Preoperative depression, anxiety, maladaptive coping, and low social support converge as components of a broader “resilience profile” linked to poorer postoperative trajectories. Biologically, resilient phenotypes are characterized by more regulated hypothalamic–pituitary–adrenal and autonomic responses and reduced inflammatory activation. Psychological therapies, prehabilitation programs, and selected pharmacological strategies show convergent, though heterogeneous, signals of benefit and can be interpreted as indirect resilience-enhancing interventions. Conclusions: Resilience appears to be a clinically meaningful, potentially modifiable construct that links psychosocial functioning, biological vulnerability, and postoperative outcomes. Incorporating resilience assessment into preoperative risk stratification and systematically embedding resilience-building strategies within perioperative and ERAS pathways may support more personalized, psychologically informed surgical care. Prospective, multidomain studies are needed to validate measurement tools, clarify mechanisms, and test resilience-targeted interventions in surgical populations. Full article

Background: Chronic non-cancer pain (CNCP) is an increasing global health concern and a multidimensional condition shaped by biological, psychological, social, and cultural factors, with impacts on functioning, quality of life, and healthcare. However, evidence remains fragmented, limiting integrated understanding and care. Objective: This study aimed to synthesize and critically analyze existing evidence on the biological, psychological, social, and cultural dimensions characterizing individuals with CNCP, and their impact on functionality, quality of life, and healthcare. Methodology: An integrative review was conducted following the Whittemore and Knafl framework. Searches were performed in Medline, Cumulative Index of Nursing and Allied Literature Complete (CINAHL), PsycINFO, Scopus, Web of Science, and grey literature in English and Spanish, without time restrictions. Studies were screened using predefined eligibility criteria and appraised with Joanna Briggs Institute tools. Data were systematically extracted and synthesized using thematic analysis to identify key attributes of people living with CNCP. Quantitative findings were summarized descriptively and mapped to thematic domains, while qualitative data were analyzed interpretively. Both evidence streams were integrated through convergent thematic synthesis. Results: Forty-four studies were included, predominantly cross-sectional and observational. Five themes emerged: biological aspects; functioning and quality of life; psychological and mental factors; social support and peer relationships; and social and gender determinants. CNCP was consistently associated with multimorbidity, sleep disturbance, psychological distress, and maladaptive coping, contributing to reduced functional capacity, greater disability, poorer quality of life, and increased healthcare utilization. Socioeconomic disadvantages and environmental constraints were linked to higher pain burden, whereas resilience and social support emerged as protective factors mitigating functional and psychosocial impact. Conclusions: Evidence largely concentrates on biomedical, functional, and psychological dimensions, whereas social determinants and healthcare quality remain comparatively underexplored. Broadening these perspectives is essential to inform public health strategies and support multidisciplinary, equitable care for individuals living with CNCP. Full article

Background: Hemophilia adversely affects several health domains and impairs the daily life of both patients and caregivers. Objectives: To assess the impact of hemophilia A without inhibitors on humanistic outcomes in adult and young patients and their caregivers in a real-life setting. Methods: This was a 12-month multicenter prospective observational study conducted in 18 Spanish hospitals. Patients who were diagnosed with hemophilia A (PWHs), without inhibitors, and who were 12 years of age or older, and their caregivers were included in the study. Results: A total of 85 PWHs (mean age: 33 years) and 12 caregivers participated in the study; 51 PWHs completed it, representing a 40% lost-to-follow-up rate. Twenty-five percent of PWHs showed maladjustment at study completion, with ‘leisure time’ and ‘work/studies’ being the most affected domains. Quality of life was particularly impaired in the sport, physical health and future areas. ‘Lying/sitting/kneeling/standing’ and ‘leisure activities and sports’ were the most impaired functions. Productivity was mainly affected by presenteeism in adult PWHs; 40 painful joint bleeding episodes were reported. Active strategies were mostly used for coping with chronic pain, and anxiety and/or depression were present in more than 10% of PWHs. Anxiety and depression were more frequently reported by caregivers. Conclusions: The study results suggest sustained impairments in adaptation to their disease, quality of life, and functionality in PWHs without inhibitors, especially related to leisure and sports activities, and a nontrivial proportion of them presented clinical levels of depression and anxiety. Overall impairment was more marked in adults than in children. In addition, due to the limited number of caregivers, their results must be considered exploratory. Full article

Background/Objectives: The prevalence of mental disorders has increased in fibromyalgia (FM). Therefore, individuals’ pain perception, emotional schemas, and coping strategies are important. Our study aims to examine emotional schemas and metacognitive levels in FM. Methods: The study included 88 FM and 88 healthy controls who consecutively presented to the clinic. All participants completed the Leahy Emotional Schema Scale-II (LESS-II) and the Metacognition Questionnaire-30 (MCQ-30). Patients were also administered the Polysymptomatic Distress scale (PSD) and the Fibromyalgia Impact Questionnaire (FIQ). Results: The study included 88 FM patients and 88 controls. In the study, the LESS-II total score and MCQ-30 score were significantly higher in the patient group compared to the control group (p < 0.05). When examining the factors affecting FIQ severity, LESS-II scores and gender variables were found to be variables predicting FIQ values (p = 0.002, p = 0.002, respectively). When looking at the factors affecting the PSD score, the LESS-II score is a significant variable predicting the PSD score (p = 0.029). Conclusions: This study demonstrated that FM patients have higher levels of negative emotional schemas compared to healthy controls, and that emotional schemas are associated with both FM symptom severity and the impact of the disease on daily life. In particular, that LESS-II scores predict PSD scores and that LESS-II and gender variables predict FIQ scores suggests that symptom burden and functional effects in FM may be closely related to cognitive-emotional processes. The findings support the importance of considering emotional schemas in FM assessment and treatment approaches. Full article

Background: Chronic pain, opioid use, and mental health disorders frequently co-occur in older adults, forming a complex and mutually reinforcing triad. Neurobiological ageing processes—such as neuroinflammation, dopaminergic decline, and impaired top-down regulation—may increase vulnerability to maladaptive coping strategies, including opioid misuse. This review aims to integrate neurobiological, affective, and clinical evidence to propose a unified neuropsychiatric framework for understanding the intersection between chronic pain, emotional distress, and opioid vulnerability in later life, while highlighting implications for integrated treatment and opioid stewardship. Methods: This structured narrative review synthesised interdisciplinary evidence from neuroscience, geriatric psychiatry, and pain medicine. The literature was thematically organised to examine shared neurobiological and psychosocial mechanisms underlying chronic pain, affective disorders, and opioid use disorder (OUD) in older adults, with attention to treatment strategies and stewardship principles. Results: Converging evidence suggests a neuroprogressive continuum linking chronic pain, emotional distress, opioid misuse, and cognitive decline. Key mechanisms include frontolimbic dysfunction, impaired reward processing, and chronic allostatic load. Therapeutic approaches that integrate analgesia with emotional regulation—such as buprenorphine, serotonin–noradrenaline reuptake inhibitors (SNRIs), and multimodal tapering strategies—may offer neuroprotective benefits. Effective opioid stewardship appears to require integrated functional, cognitive, and affective monitoring. Conclusions: Pain management in older adults may benefit from moving beyond symptom-focused approaches toward a neuropsychiatric model of care aimed at preserving homeostatic balance across sensory, emotional, and motivational domains. Within this framework, opioid therapy can be conceptualised as a potential means of functional and neuroaffective restoration, rather than solely as a strategy for risk reduction. Full article

Background: This narrative review examines the relationship between gratitude and flourishing in adults from the perspective of Positive Psychology. It departs from the traditional emphasis of psychology on mental illness, highlighting instead a comprehensive understanding of mental health that includes well-being and personal strengths. Methods: This study provides a narrative review of empirical studies published, integrating the principal theoretical and methodological contributions in this field. Relevant studies were identified through searches in PubMed, Scopus, and Web of Science. Results: The available evidence suggests that gratitude functions as a psychological resource that supports human flourishing by fostering greater life satisfaction, positive affect, and healthier physical and mental functioning. Its association with better outcomes in groups facing significant stressors (e.g., emerging adults, older adults, people with chronic pain, depression, or disabilities, forced migrants, etc.) and the promising results of gratitude-based interventions indicate that it is not only a dispositional trait but also a modifiable target for clinical and preventive programs. In addition, the findings underscore that the empirical literature on the relationship between gratitude and flourishing remains scarce and fragmented. Conclusions: Gratitude is intimately connected to flourishing, as it functions as a positive emotion-focused coping strategy that supports and enhances overall well-being. Further research is required to clarify the mechanisms involved, to examine its long-term effects on flourishing, and to determine how best to integrate gratitude and flourishing into culturally and gender-sensitive, scientific evidence-based clinical practices. Full article

Background: Spine surgeries present challenges for patients, including postoperative pain and difficulties with mobilization. Studies indicate that fear and anxiety prolong recovery; multidisciplinary care, including psychoeducation, which informs patients about their condition, addresses emotional challenges, and teaches coping strategies have benefits on recovery. Objectives: This study investigated whether preoperative psychoeducation improves outcomes in spinal surgery by reducing postoperative analgesic use and accelerating mobilization, with the hypothesis that it decreases medication needs and shortens recovery time. Methods: Data of 100 patients operated on spinal disease were analysed: 50 of them underwent microscope-assisted discectomy for lumbar disc herniation (LDH), and 50 were treated with transpedicular posterior lumbar interbody fusion (PLIF) for monosegmental instability. Each group was subdivided into a psychoeducation group (N = 25) and a control group (N = 25). All patients completed the Surgical Fear Questionnaire (SFQ). Postoperative analgesic use and time to mobilization were analysed. Results: Patients receiving psychoeducation in both groups reported lower preoperative anxiety, required fewer analgesics, and, in the PLIF group, achieved earlier mobilization. A strong correlation was found between SFQ scores and analgesic consumption (p < 0.01). Discussion: Preoperative psychoeducation reduced anxiety, decreased postoperative analgesic use, and enhanced mobilization, suggesting clinical and economic benefits if integrated into standard care. Full article