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Introduction: Mindfulness-based interventions (MBIs) are increasingly used to manage chronic pain, yet little is known about how participants develop the mindfulness skills that underlie their therapeutic benefit. Mindfulness-Oriented Recovery Enhancement (MORE) is a manualized MBI designed to foster adaptive attention and pain reappraisal. While previous research has demonstrated MORE's efficacy, the progression through which participants modify their relationship to pain remains unclear. To gain insight into individual-level experiences with MORE, we conducted a qualitative study that analyzed session recordings from a randomized controlled trial of MORE for patients with lumbosacral radicular pain (LRP) to better understand participants' evolving relationship with pain and attention. Methods: We conducted verbatim transcription and qualitative coding of 30 session recordings from the MORE program. Using iterative thematic analysis, we examined participant narratives during guided inquiry sessions to understand how they learned and applied mindfulness skills for pain management. Analysis focused on MORE’s model of processing, PURER (Phenomenology, Utilization, Reframing, Education, Reinforcement), and its role in facilitating therapeutic change. Results: Thematic analysis revealed four distinct stages in participants' progression and one common barrier: 1) Attention Dysregulation, 2a) Competency with Attention Regulation, 2b) Barrier – Experiential Avoidance, 3) Metacognitive Awareness, and 4) Pain Reappraisal. In addition, we found that some participants may engage in experiential avoidance, using their newfound attention skills to strategically avoid their pain experience. The PURER framework emerged as crucial in facilitating the cultivation of attention and adaptive engagement with pain experiences. Discussion: This study illuminates the progressive stages through which MORE participants develop adaptive relationships with chronic pain. While attention regulation skills are necessary, they initially may be used for avoidance. Therapeutic benefit appears to require guided progression through these stages with a skilled therapist. These findings suggest that mindfulness therapists should anticipate and work skillfully with initial avoidance tendencies while supporting participants' progression toward adaptive pain engagement. Conclusion: This study identified a four-stage progression in participants’ development of mindfulness skills for chronic pain: attention dysregulation, competency with attention regulation, metacognitive awareness, and pain reappraisal. Recognizing these stages can help clinicians anticipate common challenges, particularly the tendency to use mindfulness for avoidance rather than engagement. The PURER framework emerged as a critical mechanism by which therapists guide participants through these stages. These findings offer a clinically actionable model for assessing progress and tailoring mindfulness-based pain interventions to enhance therapeutic outcomes in patients with chronic lumbosacral radicular pain.
The occurrence of breast cancer during pregnancy presents signicant diagnostic, therapeutic, prognostic, and psychological challenges for both the patient and her family. Additionally, it poses potential risks to the developing fetus, complicating treatment decisions and outcomes. The frequency of pregnancy-associated breast cancer (PABC) is rising, largely due to the increasing trend of delayed childbearing and the rising incidence of breast cancer in young women of reproductive age [1]. Although breast cancer treatments during pregnancy, such as chemotherapy and surgical interventions, have been deemed relatively safe, detailed information regarding obstetric risks remains limited. Breast cancer diagnosed during pregnancy requires a delicate balance, as chemotherapy regimens might adversely affect the fetus, potentially leading to congenital abnormalities or compromising fetal survival. This case report highlights two patients with breast tumors diagnosed during pregnancy, each managed with a multidisciplinary approach to optimize both maternal and fetal outcomes. The rst patient was diagnosed with breast cancer during the rst trimester. A decision was made to proceed with chemotherapy, and the pregnancy was terminated by caesarean section at 36 weeks of gestation, following steroid coverage to ensure fetal lung maturity. The baby was delivered healthy with no apparent congenital anomalies, and the patient resumed her chemotherapy regimen post-delivery. The second patient, a known case of phyllodes tumor, presented with a rapidly progressive left breast swelling at 26 weeks of gestation. The pregnancy was managed conservatively, and the patient underwent full-term vaginal delivery at 37 weeks 4 days. A healthy baby was delivered with no apparent abnormalities, and the mother had an uneventful postpartum recovery. At 4 weeks postpartum, she underwent a left mastectomy, which was completed successfully, and the patient recovered well post-surgery. Both cases underscore the importance of a multidisciplinary approach involving obstetricians, oncologists, surgeons, and neonatologists to optimize outcomes in pregnancy-associated breast tumors. These cases demonstrate that with proper monitoring and timely interventions, good fetomaternal prognoses can be achieved, even in complex clinical scenarios.
Objective: To develop and evaluate polymeric nanospheres of Carbimazole using Nano-precipitation method. Methods: The polymeric nanospheres of Carbimazole were prepared employing the nano-precipitation method using a varied concentration of Chitosan (polymer). The prepared formulations were characterized for several parameters such as SEM, Particle size, Micromeritic properties, Encapsulation efficiency, Degree of swelling, Percentage moisture loss, drug content, and in vitro drug release and release kinetics. Results: Carbimazole-loaded polymeric nanospheres were developed, and the evaluation parameters depicted results within an acceptable range. The result of FTIR studies shows that there is no interaction between drug and excipients. The melting point, obtained as per the reference standard (122-125 °C) depicted the purity and authenticity of the drug. The micromeritics studies also supported the characterization of drug and excipients. The drug content was found to be in the range of 80.3±0.65 to 99.5±0.81 for all six formulations. The entrapment efficacy was obtained for all six formulations and ranged from 82.17 to 99.56. The release parameters were also observed for all formulations, and they were determined in the range of 82.5±0.4 for formulation NS6 (12 h) to 98.6±0.9 for formulation NS4 (24 h). Conclusion: The results revealed thatthe formulation containing a higher concentration of Chitosan and a lower concentration of Tween 80 showed prolonged in vitro drug release in a controlled manner. Hence, On the basis of all formulation results, the NS4 was the best formulation among all.
