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IntroductionPain catastrophizing describes helplessness, rumination, and magnification of a pain experience. High pain catastrophizing is an independent risk factor for disability, pain severity, inadequate treatment response, chronicity, and opioid misuse. Interdisciplinary pain programs (IPPs) are beneficial and cost-effective for individuals with chronic pain, but their functional impact on individuals with high pain catastrophizing is not well established. The emerging field of placebo studies suggests that patient-provider relationships, positive treatment expectations, and sociobiologically informed care trigger physiological responses that may enhance therapeutic interventions.MethodsIn this retrospective observational cohort study, we compared admission and discharge data for 428 adults with high-impact chronic pain (mean 8.5 years) who completed the Spaulding-Medford Functional Restoration Program (FRP). The interdisciplinary FRP team of physiatrists, behavioral health clinicians, physical therapists, and occupational therapists specializes in evidenced-based conventional rehabilitation, integrative health, and pain psychoeducation via enriched therapeutic encounters, fostering collaboration, validation, trust, self-efficacy, and positive expectations. Clinical outcome measures included the Canadian Occupational Performance Measure (COPM) assessing functional performance (COPM-PS) and satisfaction with function (COPM-SS), the Pain Numeric Rating Scale (NRS), the Pain Catastrophizing Scale (PCS), and the Patient Health Questionnaire-9 (PHQ-9).ResultsFRP participants with clinically elevated catastrophizing at baseline (PCS ≥30, mean PCS 39) achieved statistically significant improvements in function (mean delta -2.09, CHI2 = 15.56, p

The Econeurobiology of the brain describes the environment in which an individual’s brain develops. This paper explores the complex neural mechanisms that support and evaluate enrichment at various stages of development, providing an overview of how they contribute to plasticity and enhancement of both achievement and health. It explores the deep benefits of enrichment and contrasts them with the negative effects of trauma and stress on brain development. In addition, the paper strongly emphasizes the integration of Gardner’s intelligence types into the school curriculum environment. It emphasizes the importance of linking various intelligence traits to educational strategies to ensure a holistic approach to cognitive development. In the field of Econeurobiology, this work explains the central role of the environment in shaping the development of the brain. It examines brain connections and plasticity and reveals the impact of certain environmental factors on brain development in early and mid-childhood. In particular, the six key factors highlighted are an environment of support, nutrition, physical activity, music, sleep, and cognitive strategies, highlighting their potential to improve cognitive abilities, memory, learning, self-regulation, and social and emotional development. This paper also investigates the social determinants of health and education in the context of Econeurobiology. It emphasizes the transformative power of education in society, especially in vulnerable communities facing global challenges in accessing quality education.

Type I Bipolar disorder (BD-I) is a neuropsychiatric disorder characterized by manic or mixed-featured episodes, impaired cognitive functioning, and persistent work and social functioning impairment. This study aimed to investigate within-subject; (i) differences in brain perfusion using Single-photon emission computed tomography (SPECT) between manic and euthymic states in BD-I patients; (ii) explore potential associations between altered brain perfusion and cognitive status; and (iii) examine the relationship between cerebral perfusion and mania symptom ratings. Seventeen adult patients diagnosed with BD-I in a manic episode were recruited, and clinical assessments, cognitive tests, and brain perfusion studies were conducted at baseline (mania state) and a follow-up visit 6 months later. The results showed cognitive impairment during the manic episode, which persisted during the euthymic state at follow-up. However, no significant changes in brain perfusion were observed between the manic and euthymic states. During mania, trends toward decreased perfusion in the left cerebellum and right superior parietal lobule were noted. Additionally, trends indicated a higher perfusion imbalance in the left superior and middle frontal gyrus during mania and the right superior and middle frontal gyrus during euthymia. No significant correlations existed between brain perfusion, mania symptom ratings, and cognitive performance, indicating that symptomatology might represent more than neural hemodynamics. These findings suggest that cognitive impairment may persist in BD-I patients and highlight the need for therapeutic interventions targeting cognitive deficits. More extensive studies with extended follow-up periods are warranted further to investigate brain perfusion and cognitive functioning in BD-I patients.

El presente estudio tiene como objetivo evaluar la efectividad de los ejercicios hipopresivos sobre los síntomas de incontinencia urinaria y calidad de vida en mujeres adultas menopáusicas en comparación con un grupo control u otro tipo de entrenamiento de suelo pélvico. Se realizó una búsqueda en las siguientes bases de datos: PEDro, Pubmed, The Cochrane, Scielo y Science direct hasta el 06 de agosto del 2022. Se incluyeron ensayos clínicos aleatorizados que evaluaron los efectos del ejercicio hipopresivo sobre la incontinencia urinaria y calidad de vida en mujeres. Se consideró la declaración PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) para la realización de la revisión sistemática, para evaluar la calidad metodológica se utilizó la escala Physiotherapy Evidence Database (PEDro) y la clasificación Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) para evaluar el nivel de calidad de la evidencia. Fueron identificados 87 estudios de los cuales solo 3 de ellos cumplían con los criterios de inclusión. Los artículos seleccionados presentaban una muestra constituida por 266 mujeres adultas con una edad entre 42 y 68 años. Los resultados de la presente revisión sistemática indicaron un nivel de calidad de la evidencia moderado para los ejercicios hipopresivos sobre los síntomas de incontinencia urinaria y calidad de vida en mujeres menopáusicas. Palabras Claves: ejercicios hipopresivos, calidad de vida, incontinencia urinaria Abstract. The present study aims to evaluate the effectiveness of hypopressive exercises on urinary incontinence symptoms and quality of life in adult menopausal women compared to a control group or another type of pelvic floor training. PEDro, Pubmed, The Cochrane, Scielo and Science direct databases were searched until 6 of august 2022. Randomized clinical trials evaluating the effects of hypopressive exercise on urinary incontinence and quality of life in women were included. The PRISMA statement (Preferred Reporting Items for Systematic reviews and Meta-Analyses) was considered to carry out the systematic review. To assess the methodological quality of studies it was used the Physiotherapy Evidence Database (PEDro) scale and the Grades of Recommendation, Assessment, Development Classification and Evaluation (GRADE) was used to assess the quality level of the evidence. 87 studies were identified, of which only 3 of them met the inclusion criteria. The selected articles presented a sample made up of 266 adult women aged between 42 and 68 years. The results indicated a moderate level of quality of evidence for hypopressive exercises on symptoms of urinary incontinence and quality of life in menopausal women. Keywords: hypopressive exercises, quality of life, urinary incontinence.

Introduction:. Opioid consumption for those in comprehensive inpatient rehabilitation units is high because of the complexity of their injuries. Notably, pain in rehabilitation leads to worsened clinical outcomes because of maladaptive behaviors and poor engagement during therapies. It is critical to developing evidence-based pharmacobehavioral interventions. Based on principles of classical conditioning, conditioning open-label placebo (COLP) is a promising approach for reducing opioid use in comprehensive inpatient rehabilitation, and this technique takes advantage of the possibility of association learning and opioid pharmacology to promote evoked placebo-driven analgesia. Objectives:. In this brief report, we evaluate the feasibility of COLP as a pharmacobehavioral intervention to decrease total opioid consumption in patients with pain hospitalized at Spaulding Rehabilitation Hospital. Methods:. Inpatients with spinal cord injury and polytrauma (n = 20) with moderate to severe pain were randomized to receive COLP (n = 10) or treatment-as-usual for 6 consecutive days. Opioid utilization was measured by morphine equivalents using the morphine equivalent dose conversion; pain severity was assessed using the numerical visual analog scale. Results:. Conditioning open-label placebo significantly reduced total opioid consumption by the end of the intervention period (P ≤ 0.001). Pain reduction was also significant for the COLP group (P = 0.005), whereas the treatment-as-usual group demonstrated a trend towards pain reduction (P = 0.05). Conclusions:. This study presents the first data in the use of a pharmacobehavioral intervention that capitalize on the benefits of open-label placebo and classical drug conditioning for opioid dose reduction in a population with moderate to severe pain exposed to intensive inpatient rehabilitation.

Abstract Background Patterns of altered cerebral perfusion and cognitive dysfunction have been described in Bipolar Disorder (BD) acute episodes and euthymia. Knowledge of the relationship between cognitive function and perfusion in a manic state and status when followed up is still limited. Objective To describe brain perfusion alterations and its relationship with cognitive impairment in patients with BD during manic episodes and after 6 months. Methods Observational‐prospective study in 10 type I BD adults during moderate‐severe manic episodes. We assessed sociodemographic data and clinical variables as well as cognitive function through Screening for Cognitive Impairment in Psychiatry (SCIP‐S). Finally, we performed a Brain Perfusion SPECT using a Tc99m‐ethyl cysteine dimer. Results During manic episodes, patients showed cognitive impairment with a mean SCIP‐S score of 63.8 ± 17.16. This was positively correlated with perfusion measured as relative reuptake index (RRI) at the right temporal pole (ρ = 0.65 p = .0435) and negatively correlated with right the orbitofrontal cortex (ρ = −0.70 p = .0077) and the right subgenual cingulate cortex (ρ = −0.70 p = .0256). Episode severity measured by the Young Mania Rating Scale (YMRS) positively correlated with RRI at the right temporal pole (ρ = 0.75, p = .01). At follow‐up, six patients were taking treatment and were euthymic, we found a negative correlation with the YMRS and RRI at the bilateral orbitofrontal cortex (ρ = −0.8827, p = .019). They did not show significant improvement in cognitive performance at SCIP‐S, and there was negative correlation with the following of the SCIP‐S subscales; processing speed with the bilateral dorsolateral prefrontal, the bilateral medial prefrontal, the left temporal pole cortex RRI, and verbal fluency with the bilateral anterior cingulate cortex RRI. Conclusion Cognitive impairment was correlated with brain perfusion patterns at baseline and follow‐up. Large sample size studies with longer follow‐up are needed to describe the changes in perfusion and cognitive functions in BD.

Transcranial direct-current stimulation (tDCS) over the prefrontal cortex can improve signs of consciousness in patients in a minimally conscious state. Transcranial pulsed-current stimulation (tPCS) over the mastoids can modulate brain activity and connectivity in healthy controls. This study investigated the feasibility of tPCS as a therapeutic tool in patients with disorders of consciousness (DoC) and compared its neurophysiological and behavioral effects with prefrontal tDCS. This pilot study was a randomized, double-blind sham-controlled clinical trial with three sessions: bi-mastoid tPCS, prefrontal tDCS, and sham. Electroencephalography (EEG) and behavioral assessments were collected before and after each stimulation session. Post minus pre differences were compared using Kruskal–Wallis and Wilcoxon signed-rank tests. Twelve patients with DoC were included in the study (eight females, four traumatic brain injury, 50.3 ± 14 y.o., 8.8 ± 10.5 months post-injury). We did not observe any side-effects following tPCS, nor tDCS, and confirmed their feasibility and safety. We did not find a significant effect of the stimulation on EEG nor behavioral outcomes for tPCS. However, consistent with prior findings, our exploratory analyses suggest that tDCS induces behavioral improvements and an increase in theta frontal functional connectivity.

BackgroundTranscranial direct current stimulation (tDCS) modulates neural networks. Computer simulations, while used to identify how currents behave within tissues of different conductivity properties, still need to be complemented by physical models.Objective/HypothesisTo better understand tDCS effects on biology-mimicking tissues by developing and testing the feasibility of a high-fidelity 3D head phantom model that has sensing capabilities at different compartmental levels.MethodsModels obtained from MRI images generated 3D printed molds. Agar phantoms were fabricated, and 18 monitoring electrodes were placed on specific phantom brain areas.ResultsWhen using rectangular electrodes, the measured and simulated voltages at the monitoring electrodes agreed reasonably well, except at excitation locations. The electric field distribution in different phantom layers appeared better confined with circular electrodes compared to rectangular electrodes.ConclusionThe high-fidelity 3D head model was found to be feasible and comparable with computer-based electrical simulations, with high correlation between simulated and measured brain voltages. This feasibility study supports testing to further assess the reliability of this model.

ObjectiveChronic visceral pain (CVP) syndromes are persistently painful disorders with a remarkable lack of effective treatment options. This study aimed at evaluating the effects of different neuromodulation techniques in patients with CVP on cortical activity, through electreocephalography (EEG) and on pain perception, through clinical tests.DesignA pilot crossover randomized controlled study.SettingsOut-patient.SubjectsAdults with CVP (>3 months).MethodsParticipants received four interventions in a randomized order: (1) transcranial pulsed current stimulation (tPCS) and active transcranial direct current stimulation (tDCS) combined, (2) tPCS alone, (3) tDCS alone, and (4) sham condition. Resting state quantitative electroencephalography (qEEG) and pain assessments were performed before and after each intervention. Results were compared with a cohort of 47 healthy controls.ResultsWe enrolled six patients with CVP for a total of 21 visits completed. Compared with healthy participants, patients with CVP showed altered cortical activity characterized by increased power in theta, alpha and beta bands, and a significant reduction in the alpha/beta ratio. Regarding tES, the combination of tDCS with tPCS had no effect on power in any of the bandwidths, nor brain regions. Comparing tPCS with tDCS alone, we found that tPCS induced higher increase in power within the theta and alpha bandwidths.ConclusionThis study confirms that patients with CVP present abnormal EEG-indexed cortical activity compared with healthy controls. Moreover, we showed that combining two types of neurostimulation techniques had no effect, whereas the two interventions, when applied individually, have different neural signatures.

Objective: Emotional disturbance is a common complication of stroke significantly affecting functional recovery and quality of life. Identifying relevant neurophysiologic markers associated with post-stroke emotional disturbance may lead to a better understanding of this disabling condition, guiding the diagnosis, development of new interventions and the assessments of treatment response. Methods: Thirty-five subjects with chronic stroke were enrolled in this study. The emotion sub-domain of Stroke Impact Scale (SIS-Emotion) was used to assess post-stroke mood and emotional control. The relation between SIS-Emotion and neurophysiologic measures was assessed by using covariance mapping and univariate linear regression. Multivariate analyses were conducted to identify and adjust for potential confounders. Neurophysiologic measures included power asymmetry and coherence assessed by electroencephalography (EEG); and motor threshold, intracortical inhibition (ICI) and intracortical facilitation (ICF) measured by transcranial magnetic stimulation (TMS). Results: Lower scores on SIS-Emotion was associated with 1) frontal EEG power asymmetry in alpha and beta bands, 2) central EEG power asymmetry in alpha and theta bands, and 3) lower inter-hemispheric coherence over frontal and central areas in alpha band. SIS-Emotion also correlated with higher ICF and MT in the unlesioned hemisphere as measured by TMS. Conclusions: To our knowledge, this is the first study using EEG and TMS to index neurophysiologic changes associated with post-stroke mood and emotional control. Our results suggest that inter-hemispheric imbalance measured by EEG power and coherence, as well as an increased intracortical facilitation in the unlesioned hemisphere measured by TMS might be relevant markers associated with post-stroke mood and emotional control which can guide future studies investigating new diagnostic and treatment modalities in stroke rehabilitation.