Noninvasive brain stimulation is increasingly being investigated for the enhancement of cognition, yet current approaches appear to be limited in their degree and duration of effects. The majority of studies to date have delivered stimulation in "standard" ways (i.e., anodal transcranial direct current stimulation or high-frequency transcranial magnetic stimulation). Specialized forms of stimulation, such as theta burst stimulation (TBS), which more closely mimic the brains natural firing patterns may have greater effects on cognitive performance. We report here the findings from the first-ever investigation into the persistent cognitive and electrophysiological effects of intermittent TBS (iTBS) delivered to the left dorsolateral prefrontal cortex. In 19 healthy controls, active iTBS significantly improved performance on an assessment of working memory when compared with sham stimulation across a period of 40 min post stimulation. The behavioral findings were accompanied by increases in task-related fronto-parietal theta sychronization and parietal gamma band power. These results have implications for the role of more specialized stimulation approaches in neuromodulation.
Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment; however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear‐avoidance, pain catastrophizing, pain self‐efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health‐related quality‐of‐life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered “real” in an individual patient. This information can guide treatment selection when working with an individual with CLBP.
The brain changes in CLBP groups were mainly observed in areas and networks important in emotion and cognition, rather than those typically associated with nociception. This supports the understanding that emotional and cognitive processes may be the core contributor to the CLBP experience; however, future studies need to explore these processes further.
The EPS is a psychometrically sound new scale that characterizes empathy for pain and vicarious pain. The EPS offers valuable insight to the phenomenological profile of the affective, empathic and sensory dimensions of empathy for pain.
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