Towards a paradigm shift in chronic low back pain?:Identification of patient profiles to guide treatment

Kleuver, M. de [Promotor]Ostelo, R.W.J.G. [Promotor]Spruit, M. [Copromotor

Neural correlates of intrusion of emotion words in a modified Stroop task

Behavioural studies have demonstrated that the emotional Stroop task is a valuable tool for investigating emotion-attention interactions in a variety of healthy and clinical populations, showing that participants are typically more distracted by negative stimuli as compared to neutral or positive stimuli. The main aim of this study was to find and examine the neural correlates of this greater intrusion from negative emotional stimuli. Reliable reaction time (RT) and event-related potential (ER-P) data were collected from 23 participants who performed a manual emotional Stroop, task with short (40 ins) and long (500 ms) inter-trial intervals. In the short interval condition, participants were found to produce longer RTs for negative than neutral words, suggesting that these stimuli were more difficult to ignore. This RT effect disappeared in the long interval condition, although larger PI amplitudes were found for the negative words. This suggests that differences in early attention allocation may be unrelated to the degree of intrusion at the behavioural level. In addition, a larger negative slow wave around 300-700 ms post-stimulus was observed in the long interval condition, but only for those negative words that produced prolonged RTs as compared to their matched controls. This late and broadly distributed effect is believed to reflect suppression of meaning representations

Disease Explicated And Disease Defined

Disease is ubiquitous. Disease afflicts humans. It afflicts animals. It afflicts plants. People refer to disease in their everyday conversation. Newspapers comment upon it. Parliaments enact legislation regarding it. Novelists write about it. Artists depict it. Physicians, veterinary surgeons and agriculturalists seek to combat it. Insurance companies offer reimbursement against it. Anthropologists study it. Philosophers debate its nature, and dictionaries define it. Disease looms large in human consciousness. One might presume that, since disease is so important in daily life, human beings would know exactly what they mean by it. Most people seem to believe instinctively that they understand the nature of disease, and that their ideas about it coincide with other people's ideas. The definition of disease therefore arouses little controversy in everyday conversation. People use the word disease as readily as they use the words spade, or table or nose. They suggest, when they joke that somebody calls a spade a spade, that the nature of the implement used to dig the garden is so obvious that it requires no further definition. Similarly with a table or a nose. They might debate how many legs a table must have, but-regardless of the answer-rarely deny that it is a table; whilst every human must surely know what a nose is. This high level of agreement about so many commonly used terms perhaps creates an assumption that the meaning of disease is equally obvious and requires no further analysis. Is this, however, really the case? Disease is a somewhat less concrete phenomenon than is a spade or a table or a nose. Its existence, most would agree, is incontrovertible, but its nature is less clear. It is something that seems to befall people and animals and plants. It rarely serves any useful purpose. It often carries dire implications. It is something that most of us would prefer not to have, but rarely succeed in avoiding. It commonly comes unannounced and at inconvenient times. It usually causes distress, but not always. It can have a fatal outcome. Some people appear more prone to it that others. It sometimes sweeps through whole populations producing social devastation, but its manifestations vary. Some diseases affect a person's whole body, others merely a part of the body; some affect some parts of the body, others other parts. Some diseases only affect humans, whereas others affect both humans and animals. Some spread from animals to humans, others from humans to humans, and others still do not appear to spread at all. Some diseases affect plants, and few that affect plants seem to affect humans, but some humans can acquire diseases when they come into contact with plants that appear to have no diseases. Any reasonable analysis of the nature of disease must account for all these aspects and many others also. The nature of disease is a topic that has attracted the attention of physicians, scientists and philosophers over millennia. The close association that existed between medicine and philosophy in the classical Egyptian, Palestinian and Greek eras ensured that scholars who flourished in those societies examined the nature of disease. Comparable developments occurred in classical Indian and Chinese civilizations. The natural philosophers of Renaissance and post-Renaissance Europe divided into competing schools of thought over the nature of disease. More recent years have witnessed an enormous flourishing of physicians, pathologists, and agriculturalists who study aspects of disease that relate to their individual disciplines. Most of these researchers have, however, examined ever-narrower aspects of specific diseases-such as manifestations, mechanisms and causes-rather than the generic nature of the phenomenon. Some contemporary philosophers, on the other hand, have become interested in general aspects of the topic. They have proposed a number of novel ideas and reached some stimulating conclusions, although they can hardly yet claim to have reached a consensus. This lack of unanimity presumably implies that the issues involved require closer analysis if a formulation is to emerge that most of them can accept. The object of the present thesis is to undertake such an analysis. It will start by outlining in this introduction the general background to the topic. It will then detail the more noteworthy of previously proposed theories about the nature of this phenomenon, classifying them according to their most prominent components, and assessing their several strengths and weaknesses. It will next discuss the specific philosophical issues of definition, causation, and explication in the biomedical context, before suggesting a comprehensive, but succinct, definition that acknowledges many older views about disease, encompasses current usage, and provides a theoretical base from which to work into the future. It will finally test the strengths and weaknesses of that definition to account for observed phenomena and to accommodate some former definitions