Aim: The purpose of this narrative review is to discuss the interrelations between pain, stress and executive functions. Implications for practice: Self-regulation, through executive functioning, exerts control over cognition, emotion and behaviour. The reciprocal neural functional connectivity between the prefrontal cortex and the limbic system allows for the integration of cognitive and emotional neural pathways and then for higher-order psychological processes (reasoning, judgement etc.) to generate goal-directed adaptive behaviours and to regulate responses to psychosocial stressors and pain signals. Impairment in cognitive executive functioning may result in poor regulation of stress-, pain- and emotion-related processing of information. Conversely, adverse emotion, pain and stress impair executive functioning. The characteristic of the feedback and feedforward neural connections (quantity and quality) between the prefrontal cortex and the limbic system determine adaptive behaviour, stress response and pain experience.

Burnout syndrome is a distinct “occupational phenomenon” rather than a medical condition, comprising emotional exhaustion, physical fatigue, and cognitive weariness. Both exogenous work-related and endogenous personal factors determine the extent and the severity of symptoms in burnout syndrome. Persistent burnout is a cause of reduced quality of life and is associated with increased risk of sleep impairment and with several medical disorders including mild cognitive impairment, diabetes, and cardiovascular disease. Active coping strategies promoting mental resilience and adaptive behavior, stress-reducing activities, improving work conditions, and reducing exposure to work stressors together may alleviate the distress of burnout and should be introduced early in the clinical course of burnout syndrome. The purpose of this review was to explain this complex and puzzling phenomenon and to describe burnout management.

Burnout syndrome is a psychological response to long-term exposure to occupational stressors. It is characterized by emotional exhaustion, cognitive weariness and physical fatigue, and it may occur in association with any occupation, but is most frequently observed among professionals who work directly with people, particularly in institutional settings. Healthcare professionals who work directly with patients and are frequently exposed to work overload and excessive clinical demands, to ethical dilemmas, to pressing occupational schedules and to managerial challenges; who have to make complex judgements and difficult decisions; and who have relatively little autonomy over their job-related tasks are at risk of developing clinical burnout. In turn, clinical burnout among clinicians has a negative impact on the quality and safety of treatment, and on the overall professional performance of healthcare systems. Healthcare workers with burnout are more likely to make mistakes and to be subjected to medical malpractice claims, than do those who are burnout-naïve. Experiencing the emotional values of autonomy, competence and relatedness are essential work-related psychological needs, which have to be satisfied to promote feelings of self-realization and meaningfulness in relation to work activities, thus reducing burnout risk. Importantly, an autonomy-supportive rather than a controlling style of management decreases burnout risk and promotes self-actualization, self-esteem and a general feeling of well-being in both those in charge and in their subordinates. The purpose of this article is to discuss some of the elements constituting the burnout construct with the view of gaining a better understanding of the complex multifactorial nature of burnout. This may facilitate the development and implementation of both personal, behavioural and organizational interventions to deal with the burnout syndrome and its ramifications.

Mental well-being is a subjective, adaptive state of mind arising from complex dynamic interactions between cognitive, emotional and psychosocial factors. Positive mental well-being may promote good physical health, occupational functioning and academic achievement. In the moderate-to-vigorous intensity of aerobic range, regular cardiorespiratory exercise of sufficient duration and frequency has the capacity to boost resources of mental energy, to improve sleep, mental alertness and social interactions, to buffer maladaptive upregulated emotional responses to psychosocial stressors, to decrease anxiety, to moderate depressive symptoms and to support or even improve cognitive functioning.Epigenetic modification is a biological mechanism by which environmental factors influence cellular phenotype and function. Psychosocial stressors, and regular performance of aerobic exercise have opposite effects on the central nervous system, mediated at least in part through epigenetic modifications that reprogram the expression of relevant genes.Generally, physically active persons are more resilient to stress and experience fewer depressive symptoms than do physically inactive persons; and, indeed, regular moderate to strenuous aerobic activity has a mood-enhancing effect and has been proven to mitigate negative affectivity stress responses.The purpose of this narrative review is to discuss the mechanisms that appear to play a role in aerobic exercise-induced improvement in mental well-being.