Dijana Hnatešen

Aim: The aim of this cross-sectional study was to examine the relationship between pain intensity, pain catastrophizing, disability and the physical and mental dimensions of health-related quality of life (HRQoL) in patients with chronic low back pain (CLBP). Methods: The study group consisted of 152 patients with CLBP. The following questionnaires were administered: a sociodemographic questionnaire, the SF-36 Health Survey (36-Item Short Form Health Survey), the Numerical Rating Scale (NRS), the Pain Catastrophizing Scale (PCS), and the Oswestry Disability Index (ODI). Multiple linear regression analyses were conducted to examine the relationship of pain intensity, pain catastrophizing, and disability with the physical and mental dimensions of HRQoL. Results: Both regression models proved to be statistically significant. For the physical component of HRQoL, the multiple regression model was statistically significant (F(3,109) = 27.335; p < 0.001), explaining 42.7% of the variance, while for the mental component of HRQoL, the model was also statistically significant (F(3,109) = 13.611; p < 0.001) and explained 27.3% of the variance. Conclusion: Pain intensity, pain catastrophizing, and disability were identified as independent predictors of the physical component of HRQoL, whereas disability and catastrophizing emerged as the only significant predictors for the mental component. The results of this study align with the biopsychosocial model of chronic pain, which emphasizes the necessity of identifying multiple factors to ensure individualized and comprehensive treatment for individuals with CLBP.

Background/Objectives: Severe traumatic injuries of the upper extremity present a major therapeutic challenge because of extensive tissue damage, severe pain, loss of function, and substantial psychosocial consequences. Continuous multidisciplinary rehabilitation that adapts to the patient’s evolving clinical condition may optimize functional outcomes across the entire continuum of care. Methods: A 42-year-old man with no prior comorbidities sustained a severe work-related traumatic injury to his left hand. Despite reconstructive surgery and prolonged multidisciplinary treatment, he developed CRPS with persistent neuropathic pain, progressive functional deterioration, and psychological distress. Fourteen months after injury, the affected limb became completely nonfunctional, and elective transradial amputation was recommended after multidisciplinary evaluation. Results: Rehabilitation was delivered as a continuous, phase-adapted multidisciplinary program. Before amputation, treatment focused on pain control, reduction of edema and inflammation, preservation of joint mobility and muscle function, and management of CRPS using multimodal physical therapy combined with pharmacological treatment and psychological support. As amputation became inevitable, rehabilitation goals shifted toward pre-amputation preparation, promotion of adaptive neuroplasticity, and prevention of phantom limb pain. After transradial amputation, pain intensity markedly decreased, functional adaptation improved, and the patient successfully completed prosthetic rehabilitation. Conclusions: This case highlights the importance of a continuous, individualized multidisciplinary rehabilitation strategy extending from limb salvage through post-amputation recovery. Integrating multimodal physical therapy, neuroplasticity based interventions, psychological support, and prosthetic rehabilitation may improve pain control, facilitate functional recovery, and enhance long-term adaptation after severe traumatic upper extremity injury.

Background/Objectives Severe traumatic injuries of the upper extremity present a major therapeutic challenge because of extensive tissue damage, severe pain, loss of function, and substantial psychosocial consequences. Continuous multidisciplinary re-habilitation that adapts to the patient's evolving clinical condition may optimize functional outcomes across the entire continuum of care. Methods A 42-year-old man with no prior comorbidities sustained a severe work-related traumatic injury to his left hand. Despite reconstructive surgery and prolonged multidisciplinary treatment, he developed CRPS with persistent neuropathic pain, progressive functional deterioration, and psychological distress. Fourteen months after injury, the affected limb became completely nonfunctional, and elective transradial amputation was recommended after multidisciplinary evaluation. Results Rehabilitation was delivered as a continuous, phase-adapted multidisciplinary program. Before amputation, treatment focused on pain control, reduction of edema and inflam-mation, preservation of joint mobility and muscle function, and management of CRPS using multimodal physical therapy combined with pharmacological treatment and psychological support. As amputation became inevitable, rehabilitation goals shifted toward pre-amputation preparation, promotion of adaptive neuroplasticity, and preven-tion of phantom limb pain. After transradial amputation, pain intensity markedly decreased, functional adaptation improved, and the patient successfully completed prosthetic rehabilitation. Conclusions This case highlights the importance of a continuous, individualized multidisciplinary rehabilitation strategy extending from limb salvage through post-amputation recovery. Integrating multimodal physical therapy, neuroplasticity based interventions, psycho-logical support, and prosthetic rehabilitation may improve pain control, facilitate func-tional recovery, and enhance long-term adaptation after severe traumatic upper extremity injury.

Lumbar disk herniation is a common cause of pain in people older than 30, often associated with workload, where the therapeutic approach includes different methods of treatment; therefore, the aim of the study was to inspect the effectiveness of different methods of treating pain caused by lumbar disk herniation in relation to pro-inflammatory and anti-inflammatory parameters before and after two weeks of therapy. There were twenty-eight participants with a diagnosis confirmed by a specialist who also assigned the participant to a clinically appropriate type of treatment. Pain and disability were assessed using the SF-MPQ and ODI (Title: Immune Response During the Conservative and Minimal Invasive Treatment of Pain Caused by Lumbar Disc Herniation, Clinical Trials Number (NCT06545812), Initial Release 23 July 2024, Last Release 27 August 2025). In addition to the above questionnaires, serum samples were collected before and after therapy for analysis of inflammatory biomarkers. Although there was no statistically significant difference, the tendency of decreases in IL-1 beta and IL-8 in the median levels (interquartile range) was observed after conservative treatment. The results indicate role of inflammatory mechanisms in the treatment of disk herniation and support the benefits of a conservative approach through the regulation of pain, disability, and cytokine activity.

Background: Low back pain has frequently been mentioned as the most common sort of chronic pain, and numerous studies have confirmed its influence on the health-related quality of life (HRQoL). Despite a great deal of research demonstrating the important part that psychological factors play in explaining HRQoL, a therapeutic setting that prioritizes the physical domain still predominates. For this reason, the aim of this study is to assess the relationship between age, pain intensity, pain catastrophizing, depression, anxiety, pain-related anxiety, chronic pain acceptance and the psychological and physical dimensions of HRQoL in patients with chronic low back pain (CLBP). Methods: Data were collected from 201 patients with CLBP using sociodemographic data, the SF-36 Health Status Questionnaire (SF-36), the Hospital Anxiety and Depression Scale (HADS), the Pain Anxiety Symptoms Scale Short Form 20 (PASS-20), the Pain Catastrophizing Scale (PCS), the Chronic Pain Acceptance Questionnaire (CPAQ-8) and the Numeric Pain Rating Scale (NRS). The linear regression model for the dependent variable of Physical Health (SF-36 PhyH) was statistically significant (F (7, 201) = 38.951, p < 0.05), explaining 57.6% of the variance regarding the Physical Health dimension of HRQL in patients with CLBP. Results: The linear regression model for the dependent variable of Psychological Health (SF-36 PsyH) was statistically significant (F (7, 200) = 39.049, p < 0.05), explaining 57.7% of the variance regarding the Psychological Health dimension of HRQL in patients with CLBP. Conclusions: The findings of this study confirm that age, pain intensity, depression, pain-related anxiety and chronic pain acceptance are significant predictors of the physical dimension of HRQoL, while pain intensity, anxiety and depression proved to be significant predictors of the psychological dimension of HRQoL in patients with CLBP.

Low back pain has frequently been mentioned as the most common sort of chronic pain and numerous studies have confirmed its influence on Health Related Quality of Life (HRQoL). The aim of this study is to assess the relationship between age, pain intensity, pain catastrophizing, depression, anxiety, pain-related anxiety, chronic pain acceptance and psychological and physical dimensions of HRQoL in patients with chronic low back pain (CLBP). Data were collected from 201 patients with CLBP using sociodemografic data, the SF-36 Health Status Questionnaire (SF-36), the Hospital Anxiety and Depression Scale (HADS), the Pain Anxiety Symptoms Scale Short Form 20 (PASS-20), the Pain Catastrophizing Scale (PCS), the Chronic Pain Acceptance Questionnaire (CPAQ-8) and the Numeric Pain Rating Scale (NRS). The linear regression model for dependent variable Physical Health (SF-36 PhyH) was statistically significant (F(7,201) = 38.951, p <0.05), explained 57.6% of variance regarding Physical Health dimension of HRQL in patients with CLBP. The linear regression model for dependent variable Phychological Health (SF-36 PsyH) was statistically significant (F(7,200) = 39.049, p <0.05), explained 57.7% of variance regarding Psychological Health dimension of HRQL in patients with CLBP. The findings of this study confirm that age, pain intensity, depression, pain-related anxiety, and chronic pain acceptance are significant predictors of the physical dimension of HRQoL, while pain intensity, anxiety, and depression proved to be significant predictors of the psychological dimension of HRQoL in patients with CLBP.

Lumbar radicular pain is a major public health and economic problem. It is among the most common reasons for professional disability. The most common cause of lumbar radicular pain is intervertebral disc herniation, which results from degenerative disc changes. The dominant pain mechanisms are direct pressure of the hernia on the nerve root and the local inflammatory process triggered by intervertebral disc herniation. Treatment of lumbar radicular pain includes conservative, minimally invasive, and surgical treatment. The number of minimally invasive procedures is constantly increasing, and among these methods is epidural administration of steroids and local anesthetic through a transforaminal approach (ESI TF). The aim of this research was to examine the effectiveness of ESI TF as measured by a visual analog scale (VAS) and the Oswestry Disability Index (ODI), depending on whether there is contact between the herniated intervertebral disc and the nerve root. In both groups of participants, there was a significant reduction in pain intensity, but there was no significant difference between the groups. In the group with disc herniation and nerve root contact, the only significant reduction was in pain intensity (p < 0.001). There were no significant differences in measurements in other domains of the ODI. In the group without disc herniation and nerve contact, there was a significant difference in all domains except weight lifting. In the group without contact, there was significant improvement after 1 month (p = 0.001) and 3 months (p < 0.001) according to the ODI, while there was no significant improvement in the group with contact. In addition, there were no significant differences in the distribution of participants based on the ODI and whether disc herniation and nerve contact was present. The results suggest that transforaminal epidural administration of steroids is a clinically effective method for treating lumbar radicular pain caused by intervertebral disc herniation in people with and without nerve root contact, without significant differences.

This prospective study aimed to determine the cognitive and emotional status among patients with chronic pain and to examine the potential influence on the treatment success, measured by the reduction in pain intensity and adherence to pharmacotherapy. A total of seventy patients were followed for two months. The results of the comparison between patients who did and did not follow the physician’s instructions regarding adherence to pharmacotherapy showed a significant difference in cognitive status and a reduction in pain intensity. Patients who followed the physician’s instructions on taking analgesics had significantly higher scores on the Montreal Cognitive Assessment (MoCA) of cognitive status and a substantially higher reduction in pain intensity. Scores on the MoCA test provide statistically significant indications regarding patients’ decision to follow instructions regarding adherence to pharmacotherapy. Scores on the MoCA test, anxiety, age, and pain intensity (measured with a numeric rating scale—NRS) on admission were identified as potential predictors for the reduction in pain intensity. The linear regression model was statistically significant (χ² = 40.0, p < 0.001), explained between 43.5% and 61.1% of variance regarding the reduction in pain intensity. The findings of this study show that cognitive status, measured with MoCA, and emotional status, measured with the Depression, Anxiety, and Stress Scale (DASS-21), significantly influence the reduction in pain intensity and adherence to pharmacotherapy. The results suggest that cognitive and emotional status may be potential predictors of treatment success. This finding points to the importance of a biopsychosocial approach in the treatment of chronic pain, where an important emphasis can be placed on the psychosocial determinants of pain.

The aim of this study was to examine the levels of health-related quality of life (HRQoL), pain intensity, and mental distress in participants with chronic low back pain (CLBP), and to examine the differences in the HRQoL of participants with respect to mental distress and the correlations of the examined variables. Data were collected from 148 patients using the SF-36 Health Status Questionnaire (SF-36), the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) questionnaire, and the visual-analog pain scale (VAS). The results indicate poorer self-assessment of physical health (M_e = 28.1) compared to mental health (M_e = 39.4). Participants with higher levels of mental distress reported significant emotional limitations (p = 0.003), lower energy (p < 0.001), poorer psychological health (p < 0.001) and social functioning (p < 0.001), more pain (p = 0.007), and, ultimately, poorer general health (p < 0.001). The level of mental distress was related to the level of HRQoL, while a correlation with the level of pain of the participants was not found. The study results indicate a connection between the presence of mental distress and almost all aspects of HRQoL in participants with CLBP.

Despite world-level efforts and the endeavors of scientists and medical professionals in suppressing the COVID-19 pandemic, inadequate levels of vaccine literacy of the general population can represent a grave obstacle. The aim of this study was to evaluate COVID-19 vaccine literacy in the Croatian adult general population before vaccination began. The specific objectives were to test differences regarding socio-demographic characteristics and to examine perceptions and attitudes about vaccination against COVID-19 considering the level of VL against COVID-19. A cross-sectional study with a translated and psychometrically tested questionnaire was conducted in 1227 participants before the start of vaccination, from 15 to 31 January 2021. The results show a medium level of vaccine literacy (M = 2.37, SD = 0.54) and a significant difference between functional and interactive-critical vaccine literacy (p < 0.001). The level of vaccine literacy grew with the level of education (p = 0.031) and reduced with age (p < 0.001). Participants who were employed, had chronic diseases, took medicine, or consumed alcohol daily had a lower level of vaccine literacy. There is room for progress in the COVID-19 VL level for the adult population in Croatia, especially at the interactive-critical VL, which could have an important role in people accepting the vaccine against the COVID-19 disease. A satisfactory level of vaccine literacy in the population is necessary because it can contribute to the fight against the pandemic.