This article defines psychological pain as a subjective sensation, examines the factors behind its development, and outlines the cognitive and neural mechanisms underlying pain symptoms. It then discusses the role of the salience network, including the insular and anterior cingulate cortices, and its association with interoception. Subsequently, within the cognitive neuroscience framework for interpreting chronic pain, the article focuses on autonomic nervous system functions related to interoception and examines clinical symptoms such as somatic symptom disorders.

In 2000, the Japan Society for the Study of Obesity emphasized the importance of addressing obesity as a disease. Subsequently, in 2014, bariatric and metabolic surgeries, which have a significant impact on weight loss and comorbidity improvement, were included in the Japanese health insurance system. Furthermore, semaglutide, a GLP-1 receptor agonist, and tirzepatide, a GIP/GLP-1 receptor agonist, were introduced as anti-obesity medications, in 2024 and 2025, respectively, attracting considerable attention.

The misconception that obesity results from a lack of self-discipline and personal negligence has fueled widespread obesity stigma, thereby complicating treatment. Various studies have reported that the stigma of obesity is common among healthcare professionals, including physicians and nurses. Based on the findings of the WSSQ conducted among the general population in Japan, BMI was shown to increase fear of enacted stigma (FES) and self-devaluation (SD), while reducing levels of depression. Furthermore, FES was found to have a negative impact on SD, depression, and healthcare-seeking behaviors.

Thus, it is essential to gain a deeper understanding of obesity stigma in Japan and continue efforts to dispel misconceptions through sustained awareness initiatives.

Approximately a decade has elapsed since the introduction of telemedicine in Japan, with its adoption experiencing a marked surge, particularly during the COVID-19 pandemic. This expansion of telemedicine has enabled patients facing diverse barriers in regard to accessing in-person care to receive medical services with diminished physical and psychological burdens. It also facilitates stress management in patients who are predisposed to psychological distress. Beyond telemedicine, the utilization of digital tools in healthcare is undergoing significant acceleration. Notably, there is a growing trend in the development of digital therapeutics across a broad spectrum of disease areas, encompassing psychosomatic disorders. In international contexts, the exploration of integrated delivery models that amalgamate digital therapeutics with telemedicine is being actively pursued, raising the prospect of delivering healthcare that further mitigates patient burden.

Online counseling is provided through various non-face-to-face methods such as telephone, e-mail, chat, and video calls and it has been reported to be as effective as face-to-face counseling. Guidelines for online counseling call for specialized training and ICT knowledge, explanations of specific risks and benefits, protection of personal information, and appropriate handling of such information.

This paper reports the practice of online counseling in an outpatient psychosomatic clinic specializing in anxiety and depression. The provision of support based on risks and benefits has enabled the clinic to be able to flexibly accommodate patients’ international migration and schedules. While there is the advantage of being able to overcome the constraints of location and time, there are also issues such as ICT skill problems and difficulties in regard to nonverbal communication. In the future, it will be necessary to enhance various forms of support by taking advantage of the unique features of online counseling as well as to continuously improve the knowledge and skills of providers.

Occupational health activities have been conducted increasingly online since the onset of the COVID-19 pandemic. Notices from the Ministry of Health, Labor, and Welfare in Japan have set out requirements for carrying out activities online, and as a result, almost all activities by industrial physicians, with the exception of workplace inspections, can be conducted online.

An important aspect of these changes is that occupational physicians must be able to conduct remote interviews with employees upon request. A remote interview by an occupational physician may make it easier for employees and occupational physicians to access each other, but some doubts still remain as to whether sufficient relationships can be built through the online environment and whether an emergency response can be carried out appropriately. In order to determine whether sufficient occupational health activities can be conducted online, two examples of successful remote stress management are presented in this article. One is mental health guidance through remote interviews with occupational physicians, and the other is to support public health nurses using SNS. The legal and institutional positioning and practical points of the interviews were explained. Further, the possibilities of SNS utilization on health guidance are also discussed with using the “Family Nurse for LINE” service provided by Linkage, for which the author serves as the medical director.

Objectives : Laxative abuse is associated with unfavorable prognosis in patients with eating disorders. Therapists frequently struggle to manage bowel movements in such patients. This study examined the effects of laxatives with novel mechanisms of action on the treatment of eating disorders.

Methods : Data of patients hospitalized with eating disorders were collected from Kohnodai Hospital, encompassing two distinct periods : July 2016-June 2017 (before the introduction of new laxatives) and July 2021-June 2022 (after the introduction of new laxatives). The study compared the prevalence of laxative abuse, self-reported quantity of abused stimulant laxatives prior to hospitalization, and diversity of laxatives prescribed at discharge.

Results : Among the 165 and 156 patients hospitalized during these periods, 33 and 38 reported laxative abuse, respectively. The self-reported quantity of abused stimulant laxatives significantly decreased from 63.5±80.0 tablets to 34.5±81.0 tablets per day (p＝0.002). The number of patients prescribed stimulant laxatives at discharge decreased from 5 to 2, and the variety of prescribed laxatives at discharge significantly increased from 1.9±1.2 to 3.6±2.3 (p＝0.001).

Conclusion : The approval of laxatives with new mechanisms may reduce laxative abuse in patients with eating disorders before hospitalization and broaden pharmacotherapy options for inpatient treatment.