Psychological approach to chronic low back pain

Kronična križobolja jedan je od najčešćih oblika kroničnog bola, među najčešćim je povodima onesposobljenosti i izostanaka s posla i među najčešćim razlozima traženja liječničke pomoći. Usprkos brojnim suvremenim metodama liječenja, oko 30 % bolesnika s akutnom križoboljom prelazi u kategoriju kroničnog bolnog sindroma, pri čemu bol preuzima dominaciju nad životom bolesnika, njegove obitelji i bliže socijalne okoline, te oštećuje kvalitetu života. U skladu s biopsihosocijalnim modelom aktualno je stajalište da psihološke čimbenike treba sagledati kao važne odrednice u doživljaju bola i ponašanja. Psihološki procesi nisu samo reakcija na bol, nego i integralni dio doživljavanja bola. U članku se razmatra djelovanje psiholoških čimbenika koji uključuju crte ličnosti, emocionalna stanja, kognitivne i ponašajne obrasce, stresore i mehanizme suočavanja, te daje kratak prikaz postavki pojedinih psiholoških modela razvoja kroničnog bola. Budući da neprepoznate i neliječene psihološke poteškoće mogu značajno negativno interferirati s uspješnošću rehabilitacije bolesnika s križoboljom, predlažu se načini probira koji mogu poslužiti kao smjernice u identificiranju bolesnika kojima je potrebna stručna psihološka pomoć. Evaluacije psiholoških tretmana pokazuju najveću učinkovitost kognitivno-bihevioralnog i samoregulirajućih tretmana (biofeedback, relaksacija i hipnoza) u unapređivanju emocionalnog i fizičkog funkcioniranja, reduciranju specifične onesposobljenosti povezane s bolom, smanjenju depresije, poboljšanju kvalitete života, smanjenju broja posjeta liječniku i upotrebe lijekova za suzbijanje bola, kao i trajanja bolovanja. Prema suvremenom imperativu interdisciplinarnog programa rehabilitacije bola u svakodnevnoj bi praksi trebalo težiti ka ostvarivanju uvjeta za simultane intervencije fizijatra, fizoterapeuta i psihologa. Takav način rada pokazao se najučinkovitijim pristupom u liječenju križobolja.Chronic low back pain is the most common form of chronic pain, one of the most common causes of disability and work absence, and the most common reason for requiring medical help. Despite of numerous contemporary methods of medical treatment, about 30 % of acute low back patients make a transition to chronic pain sindrom which makes pain dominant over patient’s life, his/her family and close social surroundings and also impairs the quality of life. A recent scientific view, in accordance with biopsychosocial model, is that psychological factors are important determinants of pain perception and behaviour. Psychological processes are not only a reaction to pain but also a part of integral pain perception. This article considers the effects of psychological factors which include personality traits, emotional states, cognitive and behavioural patterns, stressors and coping strategies, and it also gives a short overview of certain psychological models of chronic pain development. Whereas unrecognized and untreated psychological difficulties may have a significantly negative influence on efficacy of low back patient’s rehabilitation, there are several proposed guidelines for the identification of patients that need professional psychological help. Evaluations of different psychological treatments emphasize the results of cognitive behavioural tretament and self-regulation treatments (biofeedback, relaxation and hypnosis) as the most efficient in the improvement of emotional and physical functioning, pain and disability reduction, decrease of depression, enhancement of the quality of life, reduction of the number of visits to physician and the intake of pain relief pharmacotherapy, as well as in cutting down the period of work absence. According to the contemporary imperative of interdisciplinary pain rehabilitation programs, simultaneously implemented interventions of multidisciplinary teams which include a physician, a physical therapist and a psychologist, are emphasized as the most efficient approach to the treatment of low back pain patients

The Methodological Development of an Interprofessional Educational Program to Provide Proactive Integrated Care for Elders

Background: Interprofessional collaboration in practice (IPCP) between professionals from the medical and social domain within primary care is desirable; however, it is also challenging due to fragmented healthcare. Little is known about the development of IPCP in primary care to fit the implementation context. This article describes the methodological development and the final content of an IPCP program.Methods and findings: The development process started with the identification of IPCP competencies in a literature review and a qualitative needs analysis with semi-structured interviews among eight elders and four health care professionals. The results were discussed during a first consultation with an expert team, which consisted of ten health care professionals. Consensus was reached on the themes role identity, communication, and shared vision development to form the basis of the program. A second consultation with the experts discussed the first version of the program. Then, consensus was reached on the final version of the program, which included a blended learning approach consisting of two face-to-face meetings, online learning, and on-the-job learning with a sixteen-hour time investment over a six-week period.Conclusions: The IPCP program was developed based on educational strategies and evidence, and with the support and knowledge of practice experts to fit the implementation context.

The Enzyme and the cDNA Sequence of a Thermolabile and Double-Strand Specific DNase from Northern Shrimps (Pandalus borealis)

Inge W. Nilsen et al...Background We have previously isolated a thermolabile nuclease specific for double-stranded DNA from industrial processing water of Northern shrimps (Pandalus borealis) and developed an application of the enzyme in removal of contaminating DNA in PCR-related technologies. Methodology/Principal Findings A 43 kDa nuclease with a high specific activity of hydrolysing linear as well as circular forms of DNA was purified from hepatopancreas of Northern shrimp (Pandalus borealis). The enzyme displayed a substrate preference that was shifted from exclusively double-stranded DNA in the presence of magnesium to also encompass significant activity against single-stranded DNA when calcium was added. No activity against RNA was detected. Although originating from a cold-environment animal, the shrimp DNase has only minor low-temperature activity. Still, the enzyme was irreversibly inactivated by moderate heating with a half-life of 1 min at 65°C. The purified protein was partly sequenced and derived oligonucleotides were used to prime amplification of the encoding cDNA. This cDNA sequence revealed an open reading frame encoding a 404 amino acid protein containing a signal peptide. By sequence similarity the enzyme is predicted to belong to a family of DNA/RNA non-specific nucleases even though this shrimp DNase lacks RNase activity and is highly double-strand specific in some respects. These features are in agreement with those previously established for endonucleases classified as similar to the Kamchatka crab duplex-specific nuclease (Par_DSN). Sequence comparisons and phylogenetic analyses confirmed that the Northern shrimp nuclease resembles the Par_DSN-like nucleases and displays a more distant relationship to the Serratia family of nucleases. Conclusions/Significance The shrimp nuclease contains enzyme activity that may be controlled by temperature or buffer compositions. The double-stranded DNA specificity, as well as the thermolabile feature, strengthens its potential for in vitro applications.This work was supported by the Research council of Norway, project number 138822/130, Nofima Marin and Biotec Marine Biochemicals. Since IWN and KØ are employees at Nofima Marin and LJH, ME, DRG and OL are employees at Marine Biochemicals the funders played a role in the design, data analysis and the decision to publish.Peer reviewe

Involvement of GSK-3β in TWEAK-mediated NF-κB activation

AbstractGlycogen synthase kinase-3β (GSK-3β) is a key component of several signaling pathways. We found that a short variant of `TNF-like weak inducer of apoptosis' (shortTWEAK) formed a complex with GSK-3β in a yeast two-hybrid system. We demonstrate that shortTWEAK and GSK-3β colocalize in the nucleus of human neuroblastoma cells. We also show that TWEAK is internalized in different cell lines and that it translocates to the nucleus. This event causes the degradation of IκBα, the nuclear translocation of both GSK-3β and p65, and the induction of NF-κB-driven gene expression. We demonstrate that the induction of IL-8 expression by TWEAK can be counteracted by LiCl. Taken together, these data suggest that GSK-3β plays an important role in the signal transduction pathway between TWEAK and NF-κB