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Background: Systemic and hemodynamic complications associated with stereotactic and Mayfield pin insertion pain and is one of the major problems in neuro-anesthesiology. The aim of this study was to decrease patients' hypertensive response to pain and stressful condition of the disease which may bring about problems during operation. Materials and Methods: In a randomized, double-blind clinical trial, thirty 16-65 year old ASA I and II patients at Al-Zahra Hospital of Isfahan were analyzed between September 2008 and November 2009. The level of pain according to VAS of pain was obtained from the patients in three stages: After pin insertion (stage 1), while returning from MRI (stage 2), and at the end of the procedure (stage 3) and recorded in the questionnaire. Data were analyzed through SPSS software. Results: The mean VAS of pin insertion pain for lidocaine in the three stages was 5.46, 5.00, and 2.46 and for bupivacaine was 5.76, 3.76 and 1.40, respectively (P<0.005). This indicated a significant difference between lidocaine and bupivacaine. Conclusion: As stereotactic operations take 3 to 3.5 hours on average, the use of bupivacaine instead of lidocaine is highly recommend during pin insertion.

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Background: The UN report on the 41% increase of cesarean labor and its risks in Iran in recent years on the one hand and its association with cognitive and psychological factors on the other motivated us to identify the involving variables so as to control unnecessary cesarean sections. The aim of this study was to investigate the role of fear of pain and related psychological variables (pain catastrophizing, catastrophic cognition, childbirth attitude, depression-anxiety-stress, and experience of pre-menstruation (PMS) in prediction of cesarean labor. Materials and Methods: In this cross-sectional study, 300 pregnant women from Atieh private and Shahid Akbar Abadi public Hospitals (150 participants from each) were selected and matched by variables, such as age, level of education, month of pregnancy, previous experience of deliveries, tendency to cesarean, type of hospital, and having PMS. To collect data, a battery of questionnaires, including fear of pain, pain catastrophising, catastrophic cognition, childbirth attitude, and depression-anxiety-stress (DASS) were used. The results were analyzed through correlation coefficient and logistic regression. Results: Education, previous experience of deliveries, month of pregnancy were not significant but such variables as the tendency to cesarean, type of hospital, and age were significant (P<0.05). Such variables as pain catastrophizing, catastrophic cognition, and childbirth attitude were significant but other variables, including fear of pain , depression-anxiety-stress, experience of PMS were not significant (P>0.05). Conclusion: Such variables as the experience of cesarean, type of hospital, and age as well as pain catastrophizing, childbirth attitude, and catastrophic cognition are significant variable in prediction of cesarean labor in pregnant women.

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Background: Peripheral neuropathy is a common complication associated with diabetes mellitus. It has been shown that oxidative stress is an important etiological factor in neuropathy which contributes to its development however, the exact pathophysiology underlying this complication is not fully understood. This study was designed to examine the effect of regular exercise and vitamin C administration on pain threshold in rats. Materials and Methods: In this experimental study, 36 male Wistar rats (220±10 g) were allocated to control and diabetic (control, vitamin C, exercise, and exercise+ vitamin C) groups. Diabetes was induced by the subcutaneous administration of streptozotocin (60 mg/kg). A week after the induction of diabetes, the rats were subjected to swimming training and vitamin C treatment for 8 weeks. At the end of weeks 3, 5, and 8, Tail-Flick test was done on the rats to assess pain threshold. Data were analyzed using SPSS software. Results: Diabetes significantly decreased pain threshold in the rats. Diabetes-induced hyperalgesia was significantly decreased by training and vitamin C. Concurrent effects of training and vitamin C on thermal pain threshold were significantly higher than each of them alone. Conclusion: Regular exercise together with vitamin C administration can be a proper method for preventing thermal hyperalgesia associated with diabetes. Therefore, they can be effective in the treatment and management of pain

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Background: Pain is a complex problem, which can affect patients' physical and psychological condition. Inadequate postoperative pain control has adverse effects on the patients' physiological, metabolic and mental condition. Adding new supplement will increase the duration of analgesia. This study aimed to comparison of intratechal neostigmine and midazolam in increasing the time of postoperative analgesia. Materials and Methods: In this randomized double blind clinical trial, 60 patients with ASA class Ι, II who were candidate for elective colporrhaphy surgery under spinal anesthesia were randomly divided into 3 groups of 20 patients. All patients received hyperbaric lidocaine 5% and groups I received 1 mg midazolam, groups II received 50 μg Neostigmine and groups III received 0.5 cc normal saline additionally. Then according VAS pain score, postoperative painless duration and pain score were compared between groups by running SPSS software. Results: Mean of painless duration in the Midazolam, Neostigmine and control groups were 98.4±18.2, 74.5±32.6 and 64.5±9.9 minutes respectively which was significantly longer than in Midazolam group (p<0.001). The mean dose of requested analgesia in first 24 hours after surgery was significantly lower in Midazolam group (p<0.001). Conclusion: Inthrathecal midazolam and Neostigmine as a complementary medication to lidocaine 5% can increase painless duration in colporrhaphy surgery and midazolam is more effective than Neostigmine. Key Words : midazolam & Neostygmine , Spinal anesthesia, painless time , colporrhaphy

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Background: Transient hip tenosynovitis is one of the common causes of pain and limping in children and includes 0.4% to 0.9% of admissions in emergency wards. The aim of this study is to evaluate this disease in terms of clinical presentations, age and sex distribution, and six-month recurrence. Materials and Methods: In this cross-sectional study, 51 children with diagnosis of transient hip tenosynovitis were investigated. Inclusion criteria were physician's clinical suspicion of acute tenosynovitis according to clinical presentations, physical exam, and age range of 3 to 8 years. Results: Among the 51 children with tenosynovitis, 34 patients were male with age of 61.70±19.1 months and 17 patients were female with mean age of 48.35±20.49 months that presented a significant statistical difference (p=0.026). The most common complaint was hip pain and the most commonly involved joint was the hip. Also, most of the patients had the history of viral diseases. Conclusion: Transient hip tenosynovitis is more common in boys. The right hip is the most involved joint and the majority of patients have the history of recent viral diseases.

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Introduction: Paints are composed of extensive variety of hazardous substances, such as organic solvents and heavy metals. Occupational exposure to paint increases oxidative stress, hematological disorders, and DNA injury. This study was performed to explore the beneficial effects of Selvit on the paint workers by measuring total antioxidant capacity, lipid peroxidation, and blood parameters as main oxidative stress biomarkers.

Materials and Methods: This clinical trial study was conducted on 25 male workers who worked in the paint factory. Serum markers such as total antioxidant capacity (TAC), lipid peroxidation (LPO) and also hematological parameters were measured before and after using Selvit (14 days). SPSS software was used for data analyses and paired t-test and Pearson correlation analysis were applied.

Results: Results showed that after using the Selvit, an increase in TAC and a decrease in LPO were observed but they were not significant. Also, aspartate transaninase significantly decreased after using Selvit and high density lipoprotein significantly increased.

Conclusion: Selvit have beneficial effect on hematological parameters due to its antioxidant capacity.

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Background: Diabetes mellitus is a common metabolic disorder that is associated with many complications such as peripheral neuropathies. This study was designed to investigate the effect of Brassica juncea on peripheral neuropathic pain in diabetic rat.

Materials and Methods: In this experimental study, male Wistar rats (250±20 g) were divided randomly to normal and diabetic (control, B. juncea extract at doses 150 and 300 mg/kg) groups. Experimental diabetes was induced by the intraperitoneal injection of streptozotocin (60 mg/kg). After four weeks treatment, animals were subjected to Tail-flick test to evaluate pain threshold and data were analyzed using SPSS software. Statistical significance was considered at p<0.05.

Results: The results of this study showed that diabetes significantly decreased pain threshold in the rats. Also diabetes-induced hyperalgesia was significantly decreased by treatment with extracts of B. juncea at doses 150 and 300 mg/kg (p<0.05 and p<0.01, respectively).

Conclusion: Our observation indicates that B. juncea could be a therapeutic option for control and treatment of hyperalgesia associated with diabetic neuropathy in diabetic patients. However, further studies are required to elucidate the antinociceptive effects of B. juncea.

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Background: There have been numerous reports of snake venoms being employed as analgesics in attempts to relieve severe pain associated with cancer, immune dysfunction and viral infections. This study investigates the antinociceptive effects of iranian cobra snake venom (Naja naja oxiana) in comparison with morphine and lidocain on laboratorial femal mice.

Materials and Methods: This study has been done on 48 NMRI female mice of 18-20 g in weight. Antinociceptive activeity of snake venom was evaluated by formalin test. In this test, the animals were divided into 6 groups (each group consisting of 8 mice): Sham, positive Control (receiving morphine at dose of 5 mg/kg, and receiving lidocain at dose of 20 mg/kg), and experimental groups receiving venom at doses of 1, 3 and 4.5 µg/mice. In all groups, the formalin test was recorded for 60 min after administration of venom and drugs in mice. Data were analyzed using one-way ANOVA and Tukey test.

Results: The results showed that the venom of Naja naja oxiana decreased nociception meaningfully in both acute and chronic phases. We also showed that this venom revealed even a better analgesic activity in comparison with morphine and lidocain.

Conclusion: This study showed that the antinociceptive effect of the venom was mediated through central nervous system and peripheral mechanisms. Although details of the mechanism remain unclear, and further studies should be considered to demonstrate its therapeutic effects.

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Background: Subacromial impingement is one of the most common complaints of shoulder. Treatments include avoiding of painful activities, oral anti-pain drugs, physical therapy modalities, corticosteroid injection and exercise therapy. Some studies have shown that platelet- rich plasma(PRP) is effective on tendinitis and tearing of tendons, ligaments and muscles, but evidence that has proved PRP as a conservative treatment in shoulder pathologies is very limited. This study aims to investigate the effect of PRP injection on relieving pain and improving daily function of patients with shoulder impingement syndrome.

Materials and Methods: In this clinical trial study, patients older than 40 with pain more than three months were included. If they had three of four positive diagnostic clinical tests of shoulder impingement that were confirmed by shoulder MRI, could be injected PRP twice. The time between injections was 1 month. Pain was measured by visual analog scale (VAS) and function was measured by two questionnaires named disabilities of the arm, shoulder and hand (DASH) and western Ontario rotator cuff  (WORC) index. Range of motion (ROM) of shoulder was measured in five directions by goniometry . All of these parameters were evaluated before intervention and in 1, 3, 6 months later.

Results: with due attention to a six-month folloe-up, PRR injection was effective in pain reduction and improvement of patient's function (p<0.05). Shoulder Rom increased in all directions except external rotation and the power of shoulder muscles was evidently improved statistically in flexion, abduction and internal toration.

Conclusion: PRP injection could effectively reduce pain and improve daily activities in patients with shoulder impingement syndrome.

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Background: MgSo4 (magnesium sulfate) is the first therapeutic line for preeclampsia. Recently, there have been many debates on pain relief property on MgSo4. The purpose of this study is to evaluate the effect of MgSo4 on pain relief after cesarean in preeclampsia parturient

Materials and Methods: In this analytic and cross-sectional clinical trial study, 88 pregnant wowen with mild preeclampsia who received MgSo4 (14g loading dose and 5 g/4h maintenance dose) (n=88, P group), were compared with 88 normal pregnant women(n=88, N group), according to the duration of paim relief and the amount of diclofenac suppository consumption after cesarean section from March 2013 to October 2014. After cesarean section, the assessment of pain relief performed with NRS (numerical rating scale), and diclofenac consumption.

Results: P group had a longer analgesic duration than N group. NRS in P group was significantly longer than N group(6.89 ±3.34 vs. 3.55± 2.13 hr, p=0.0001). The dose of diclofenac suppository in P group was significantly lower than N group (225mg±147 vs. 365.9±92mg, p<0.0001).

Conclusion: Post cesarean pain in preeclamptic group was significantly lower than non-preeclamptic group. This finding is probabley because of MgSo4 administration in preeclamptic group.

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Background: Hysterectomy is one of the most common surgical procedures. Only after cesarian section, hysterectomys considered as second major surgical procedure. Problems such as severe pelvic pain, irregular or heavy bleeding and uterine cancer are cases that hysterectomy is used to care them. Abdominal pain after abdominal hysterectomy is one of the most common complaints of patients undergoing this type of surgery. This study aimed to compare the effects of bupivacaine into the subcutaneous tissue and skin ketamine to control pain after surgery in patients undergoing abdominal hysterectomy under general anesthesia.

Materials and Methods: This study is a randomized, double-blind clinical trial involving 99 women candidating for TAH referred to Taleghani center in Arak who were divided into three groups. The average duration of analgesia and pain and pain score were recorded.

Results: The average duration of analgesia in ketamine group, in the bupivacaine group and in the placebo group was 65.1±8.8, 65.4±8.7, and 57.6±5.5, respectively. According to p≤0.01, there was a significant difference between the three groups. The duration of analgesia in the placebo group was significantly lower than ketamine and bupivacaine groups, while that between ketamine and bupivacaine in terms of the average duration of analgesia, no significant difference was observed.

Conclusion: The results of our study indicate that the use of bupivacaine and cutaneous ketamine is effective in reducing postoperative pain in patients undergoing abdominal hysterectomy and further doses of ketamine and bupivacaine single dose resulted in a significant reduction of postoperative pain in patients compared to the placebo group.

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Background: The definite treatment of indicated Hypertrophy of the tonsils is Tonsillectomy. The aim of this study was to compare the efficacy and necessity of diclofenac suppository and simultaneous prescription of acetaminophen alone in controlling and reducing pain and improving swallowing and satisfaction after surgery for tonsillectomy in children.

Materials and Methods: In this clinical trial, 180 children 7 to 14 years Tvnsykltvmy surgery were enrolled. Patients in an improbable way, easy and were divided into three groups of 60. Immediately after the surgery acetaminophen, diclofenac, or a combination of both was used. The cases of pain in the early hours, seventh, thirteenth and nineteenth after surgery were compared.

Results: There was a significant difference between the average pains of all groups in all hours (p<0.05). There was a significant difference between the groups from the point of view of side effects such as Nausea, Vomiting and Pyrexia (p<0.05), But there was no significant difference between the groups from the point of view of After Surgery Bleeding (p>0.05).

Conclusion: We can say that Rectal Diclofenac is a more effective medication for reducing pain after the Tonsillectomy surgery in contrast with Rectal Acetaminophen or a mixture of the two, which may cause the patients to use less Narcotics after the surgery.

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Background: Neuropathic pain is a chronic pain that affects on the patient’s quality of life. Use of herbal instead of synthetic drugs recently has been increased due to side effects of synthetic drugs and herbal effective components. Flavonoids are herbal compounds that have analgesic and anti-inflammatory effects. Because Allium cepa L. has a great amount of flavonoids, this study has been designed to evaluate analgesic effects of alcoholic extract of Allium cepa L. on neuropathic pain behavior in chronic constriction injury model in rats.

Materials and Methods: In this experimental study, neuropathic pain induced by chronic constriction injury (CCI model) in Rats. Animals were randomly divided into 4 groups (n=10 for each): Sham, CCI model, receiving red onion hydroalcoholic extract at a dose of 100 mg/kg and a group receiving gabapentin (100 mg/kg). Red onion extract and gabapentin were administered by gavage for 21 days. Using thermal hyperalgesia, mechanical and thermal allodynia tests, the analgesic effects of extract have been measured.

Results: Findings of this study revealed that CCI surgery on rats induced hyperalgesia, mechanical and thermal allodynia. Daily intakes of alcoholic extract of red onion and gabapentin significantly increase the paw withdrawal latency; increase the threshold to mechanical allodynia and decrease in response to acetone.

Conclusion: Oral use of alcoholic extract of Allium cepa L. reduces neuropathic pain behavior in CCI model in rats.

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Abstract

Background: The aim of this study is to evaluate the impact of preemptive adding topical Ketorolac to Tetracaine drop on pain intensity and hemodynamic parameters during and after cataract surgery.

Materials and Methods: Eighty patients scheduled for elective cataract surgery under sedation and topical anesthesia, were randomly allocated to two equal groups: group T received Tetracaine 0.5%, and group TK received Tetracaine with ketorolac eye drops. One drop of each ophthalmic drug was applied every 10 minutes from 30 minutes before surgery. Pain intensity and hemodynamic parameters were assessed just before starting the operation and 5, 10, 15and 20 minutes during the operation, and then 0, 5, 10, 15 and 20 minutes after arrival of the patient to the recovery room.

Results: Mean pain intensity was significantly lower in TK group (1 ± 0.128) compared with T group (2 ± 1.54) during the surgery (p = 0.003), but there was no significant difference between the two groups in this regard during the recovery time (p =0.157). The number of patients requiring additional analgesic was not significantly different between the groups. There was no significant difference between the two groups regarding hemodynamic parameters except at 20th minutes and 15^th and 20^th minutes (heart rate and respiratory rate) after arrival to the recovery room.

Conclusion: Preemptive adding topical Ketorolac to Tetracaine drop is more effective than Tetracaine alone to reduce pain during cataract surgery.

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Abstract

Background: Pain is a protective process in the body. There are different pathways for pain control in the central nervous system. Descending pain control system is one of pathways. The periaqueductal gray (PAG) is a structure known for its role in pain transmission and modulation. The aim of this study is to investigate the percent of interaction between the left and right PAG in unilateral left foot induced pain.

Materials and Methods: In this study, 60 rats (280+30g) in six groups were used (3test groups and 3 controls groups). In test groups, 0.5 microliter lidocaine was injected in the left PAG, right PAG or both to make local anesthesia. In control groups, 0.5 microliter of normal saline were injected. After 15 minutes, 50 microliter of 2.5% of formalin were injected subcutaneously to right hind paw of rats and nociception was detected in every 15 seconds for one hour.

Results: The induction of unilateral pain (left hind paw) in rats, can affect not only the ipsilateral but also the contralateral PAG nucleus.

Conclusion: This study showed that the left and right PAG nuclei have significant role on unidirectional nociception in formalin test in rats. The contralateral PAG, however, has a minor effect on nociception.

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Background and Aim: Musculoskeletal disorders are mainly prevalent among college students who experience direct contact with patients. This study aimed to determine the prevalence of musculoskeletal pains among Rehabilitation, Dentistry, and Nursing students at Arak University of Medical Sciences in 2017-2018.
Methods & Materials: In this cross-sectional descriptive study, 538 students of Arak University of Medical Sciences were recruited using the convenience sampling approach. Variables included age, sex, body mass index, study field, hours of using smartphone per day, and nine symptom sites being neck, shoulders, upper back, elbows, low back, wrist/hands, hips/thighs, knees, and ankles/feet. The researchers assessed the musculoskeletal pain by using the Nordic questionnaire and demographic questionnaire. Statistical analysis was performed using SPSS V. 18.
Ethical Considerations: The Research Ethics Committee of Arak University of Medical Sciences approved this study (Code: IR.ARAKMU.REC.1397.253).
Results:  In this study, 538 students (205 males and 333 females) were studied with Mean±SD age of 22.04±2.53 years old. The results showed that the prevalence of musculoskeletal pain in the spine (neck 29.4%, upper 24.3%, and lower back 37.2%) was higher than in upper and lower extremities. Musculoskeletal pain in the shoulder, upper, lower back, and thigh were significantly different based on sex. Also, musculoskeletal pain in the neck and ankle, and foot were significantly different based on age (P<0.05). There was a significant difference between musculoskeletal pain of back and ankle based on smartphone use hours per day.
Conclusion: This study suggested that rehabilitation, nursing, and dentistry students are at risk for musculoskeletal pain, especially in the lumbar, cervical, and upper back. 

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Background and Aim: Patients with the symptoms of gastrointestinal diseases and ulcers constitute a large number of patients referring to general and internal clinics. Furthermore, preliminary studies on gastric ulcers highlighted the role of psychological factors in the development of a susceptible gastric ulcer. The current study aimed to determine the effects of Cognitive-Behavioral Therapy (CBT) on pain intensity and stress coping styles in patients with gastric ulcers.
Methods & Materials: This was an experimental study with a pretest-posttest-follow-up and a control group design. The statistical population included all patients with a gastric ulcer who were referred to public health centers in Tehran City, Iran, in the winter of 2018. Among the volunteers participating in the study, 30 patients with gastric ulcers were selected by the convenience sampling method. Next, they were randomly assigned to the experimental and control groups (n=15/group). Measurement tools included the McGill Pain Questionnaire (MPQ) and the Coping Inventory for Stressful Situations (CISS; Endler & Parker, 1990). The experimental group subjects participated in eight 90-minute sessions of CBT. However, the controls received no psychological treatment in this period. For data analysis, repeated-measures Analysis of Variance (ANOVA) and post-hoc tests were applied.
Ethical Considerations: This study was approved by the Research Ethics Committee of the Islamic Azad University, Karaj Branch (Code: IR.IAU.K.REC.1397.85).
Results: The present research results signified that CBT improved problem-oriented coping styles (P<0.01) and decreased emotion-focused coping styles (P<0.01) and avoidance (P<0.01) in the test group. Besides, the mean scores of pain intensity decreased in the experimental group, compared to the controls (P<0.01).
Conclusion: The provided CBT was effective on pain intensity and stress coping styles in patients with gastric ulcers.

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Background and Aim: In every age of history, human beings have been afflicted with the fear of disease. Undoubtedly, cancer is among the most concerning diseases; cancer pain is among the major pains. The present study aimed to compare the effects of cognitive-behavioral group therapy and mindfulness-based cognitive therapy on multidimensional pain symptoms in patients with breast cancer.
Methods & Materials: The present study was applied concerning the purpose and applied a quasi-experimental with pretest-posttest, a two-month follow-up, and control group design. The statistical population was all women with breast cancer referring to Tehran Cancer Research Center in 2018 who were selected by convenience sampling method, consisting of 30 patients. They were randomly divided into two groups of intervention and the control group. The repeated-measures Analysis of Variance (ANOVA) was used to analyze the obtained data. The research instrument was a multidimensional pain questionnaire (West Hyun-Yale) to evaluate multiple pain indices.
Results: The current study results suggested that cognitive-behavioral therapy and mindfulness-based cognitive therapy were effective on pain experience (P<0.001); however, there was no significant difference between the intervention groups respecting pain experience.
Conclusion Based on the present research findings, cognitive-behavioral therapy and mindfulness-based cognitive therapy impacted the management and pain intensity of patients with breast cancer.

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Background and Aim: Research has shown that social power affects information processing in many ways and can induce powerful movements or gestures. This study aimed to investigate the effect of pretending power gestures on changing the pain threshold of a group of female students.
Methods & Materials: The method of the present study was quasi-experimental with a pre-test post-test design with a control group. The statistical population of this study included all female students of Arak University in the academic year 2016-2017, from which 60 people selected by convenience sampling method, and randomly divided into three groups: high power posing (sitting on a chair and putting your feet on the table, placing your hands behind your head and holding your head up), low power posing (sitting on a chair with your legs together, arms between your legs and bending your head to bottom) and control. Rosenberg self-esteem scale and tourniquet technique with cuff pressure gauge (to measure pain threshold) used to collect data. After the pre-test measurements and two minutes of gestures, the post-test was performed immediately. Data were analyzed using the analysis of covariance.
Ethical Considerations: This study was approved by the ethics committee of Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1399.276).
Results: The results showed that pretending high/low power gesture significantly affects pain threshold; pretending to have a high-power gesture increases the pain threshold, and pretending to have a low-power gesture lowers the pain threshold.
Conclusion: Based on the results, using power gestures as a simple tool in pain situations is recommended for pain management or as a supplement to analgesics.