Journal of Anesthesiology and Pain
Year:2017 | Volume:7 | Issue:4|Papers Count:11

Aim and Background: study is aimed to investigate the efficacy of dialectical behavior therapy techniques in reducing pain catastrophizing in patients with preoccupied attachment style suffering musculoskeletal chronic pain.Materials and methods: This study is based on multiple baseline design. The protocol was done in 12, 60-minute sessions on 2 female patients suffering chronic back pain. Also 2 baseline sessions and one 1-month follow up session were done. Catastrophizing questionnaire (PCQ) and relationship scales questionnaire (RSQ) were filled by subjects in 5th, 7th, 9th, 11th, 14th baseline sessions and the follow up session. Results of treatment were analyzed by visual inspection, recovery percentage, and effect size methods.Findings: According to results Dialectical Behavior Therapy was effective in reducing catastrophizing as an attachment behavior in patients with preoccupied attachment style. Also these effects were maintained greatly in patients in the follow up session.Conclusion: Psychological as well as medical treatment can be helpful in patients with chronic musculoskeletal pain.

Aim and Background: Pain management is an important component of patient care; in which nurses play a key role. In this regard, Knowledge of health care providers about pain management is very important and it is a part of patient’s right.Materials and methods: This is a descriptive study which assesses the knowledge and attitude of practitioner nurses in Jiroft University of Medical Sciences about pain management.Findings: The results showed that more than 70% of nurses had negative to moderate attitude and 71.6% of them had a low level of knowledge about pain management.Conclusion: According to the results and the problem that most nurses did not have enough knowledge about pain and as they showed negative attitude towards pain management, it is essential to provide continuous education for the nurses in pain management.

Aim and Background: Intra operative bleeding is an inevitable complication of endoscopic sinus surgery (ESS), besides it is worring for both anesthesiologist and otolaryngologist. The aim of this study was the survey of relationship between tranexamic acid (TA) dose and the amount of bleeding and duration of surgery in patients with chronic rhinosinusitis.Methods and Materials: This randomized double-blinded clinical trial was performed on 100 patients with class I and II ASA (American Society of Anesthesiologists) who were scheduled for endoscopic sinus surgery under general anesthesia.50 patients (groupL) received 5 mg/kg of TA, and another 50 patients (groupH) received 10 mg/ kgof TA after tracheal intubation. Anesthesia plan was the same in both groups. Intra operative bleeding, systolic and diastolic blood pressure (BP), and heart rate (HR) at 15th, 30th, 60th, 120th, 150th minutes, surgeon satisfaction rate, duration of surgery, and complications were documented. Data was analyzed by SPSS-19 software.Findings: Statatistical analysis showed that there was no significant difference considering demographic data between the groups. Surgical time was not significantly different between the groups (p=0.83), but the mean blood loss amount based on mililiter and the percent of maximal allowable blood loss (MABL) were less in group H. And the surgical field was better in group H.Conclusions: In this study it was shown that administration of 10 mg/kg TA intravenously has been effective to achieve less blood loss, and to improve the quality of surgical field during endoscopic sinus surgery without any significant side effects.

Aim and Background: Studies indicate that chronic pain is a comprehensive medical complaint, in a way that many adults are engaged in this process. Thus in this study the aim was to examine the structural relationship of early maladaptive schemas and pain with the mediating role of mindfulness in university students.Methods and Materials: The participants included 201 undergraduate students who were chosen by multistage cluster sampling method. Young early maladaptive schema scale, FFMQ, and Mac-Gill pain Questionnaire were administered. Structural equation modeling (SEM) and Bootstrap tests were conducted to explore direct and indirect pathways of study’s model, respectively.Findings: Results showed that early maladaptive schemas and pain are antecedents and consequences of mindfulness in students, respectively. The results indicate that mindfulness has a significant mediating role on the relationship between early maladaptive schemas and pain. The tested model is a fit model to explain university students’ pain.Conclusions: The results showed that early maladaptive schemas and dispositional mindfulness are the main determinants of chronic pain.

Aim and Background: Based on existing scientific information Thymus vulgaris is a medical herb which has anti- inflammatory effects. Visceral pain is an unpleasant feeling, however its treatment with NSAIDs results in serious side effects such as gastric ulcer, blood dyscrasia and Renal failure. In order to decrease these side effects and the dosage of drugs, co-administration of synergistic herbal medicine with these drugs can be a solution. The aim of this study was to evaluate the palliative interactive effect of hydroalcholic extract of Thymus vulgaris and Flunixinmeglumine on visceral pain.Methods and Materials: This experimental study was performed on 40 N-MRI male mice (36±4g).Animals were randomly divided into five groups: Negative Control group treated with normal saline, Positive Control group treated with Flunixin (2 mg/kg) and treatment groups receiving Flunixin (1mg/kg), Thymus vulgaris (100mg/kg) and both Thymus (100mg/kg) plus Flunixin (1mg/kg). All these groups received drugs and hydroalcholic extracts via intraperitonial injection. The Mices were injected with acetic acid 0.6% (10ml/kg) for visceral pain induction, and 15 minutes after each intraperitoneal administration, palliative effects were recorded by counting the number of Writhing during 30 minutes. The data was analyzed by SPSS using One-Way ANOVA (Tukey) test. The significant value was shown with p<0.001.Findings: The positive control group and treatment groups showed a significant reduction in pain response when compared to negative control group (p<0.001). Both Postive control and Thymus-Flunixin groups had a significant reduction in pain response in comparison with both Flunixin and Thymus groups (p<0.001) but they showed no significant difference relative to each other (p>0.001).Conclusions: Co-administration of Thymus vulgaris and Flunixin results in synergistic analgesic effect.

Aim and Background: Electroconvulsive therapy (ECT) is considered as the most effective treatment method for major depression and psychiatric disorders. Significant hemodynamic changes occur in patients treated with ECT and the duration of seizure after ECT is considered as an important factor in the success of this treatment method. This study aimed to compare the effect of etomidate and propofol on seizure duration and hemodynamic parameters in ECT.Methods and Materials: This study is a double blind clinical trial on 27 patients (54 patient sessions), aged 12-60 years with ASA class I-II. In the first patient session induction of anesthesia for ECT was applied by either propofol (2 mg/kg) or etomidate (0.2 mg/kg) and for the second patient session (with a time interval of 48 hours) the other drug was applied. Systolic blood pressure, diastolic blood pressure and heart rate were measured and recorded in four stages of ECT once before and then 1, 3 and 5 minutes after ECT. Seizure duration was measured in each session. Data analysis was applied by SPSS software and a P value<0.05 was considered significant.Findings: The mean age of participants in this study was 35.9±10.4. The mean duration of seizure during propofol and etomidate anesthesia was 35.14 and 35.74 seconds, respectively (P=0.240). Mean systolic and diastolic blood pressure and heart rate every time after seizure during propofol anaesthesia was less than etomidate (P=0.05).Conclusions: There was no significant difference regarding seizure duration and hemodynamic changes subsequent to ECT, between propofol and etomidate anesthesia.

Aims and background: Intraoperative blood loss during craniotomy for brain tumor excision needs blood transfer in most of the cases. Tranexamic acid is an anti-fibrin lytic drug. The aim of this study was to evaluate the effect of Tranexamic acid on intraoperative blood loss in patients undergoing craniotomy for brain tumor excision.Materials and Methods: Fifty patients suffering from brain tumor underwent craniotomy. Thirty minutes before incision, patients were randomly allocated into two groups of intervention (Tranexamic acid) or control group (normal saline). Fifteenmg/kg Tranexamic acid in combination with 500 cc normal saline in a 30 minutes period was injected in the form of bolus in the intervention group. In control group, patients received normal saline in same amounts. Intraoperative blood loss was estimated by observing Suction bottles, weighting the used medical gauzes and the remained blood on the surgery field during the surgery. This was done by counting small cotton and converting the surgery field to used medical gauzes. Blood loss was measured every one hour.Findings: The mean blood loss during surgery in the intervention group was 858±314 and 1050±398 in the control group. Although this amount was less in intervention group, the trend was not significant (P=0.076).Also the mean amount of estimated blood loss in intervention group was 798 ± 365 and 906±378 in the control group (P=0.31).Conclusion: Tranexamic acid administration may decrease the blood loss but this study could not observe any significant trend. The number of blood pack cells and estimated blood loss were not significantly different in two groups of intervention and control.

Aims and Background: Despite the rapid growth and prevalence of obesity, the impact of obesity on outcome of exercise therapy in patients with chronic non-specific low back pain is still uncertain. The aim of this study was to investigate whether obesity can affect the efficacy of exercise therapy on pain and disability of patients with chronic non-specific low back pain.Materials and Methods: Study subjects include 32 male and female (21 men and 11 women) patients with chronic non-specific low back pain. They were classified Based on body mass index (BMI) and waist-to-hip ratio (WHR) into two groups of obese subjects (6 men, 4 women; mean age: 52.3±5.85 and BMI 32.45±2.15) and non-obese (15 men and 7 women; mean age, 51.81±7.10 and BMI 24.5±1.91). To assess pain visual analogue scale (VAS) was used and Roland Disability Questionnaire - Morris (RMQ) was used to assess back pain disability. Exercise program consisted of seven exercises which was carried out for 10 weeks, three times a week for 30 to 60 minutes. Data was analyzed by independent t test, ANOVA and Pearson correlation tests with the significant level of less than 0.05.Findings: The results showed a significant difference between pain intensity (F=-2.88, P=0.007) and disability (F=-2.16, P=0.04) of obese and non-obese subjects with chronic non-specific low back pain in pretest. A statistically significant relationship between body mass index and pain severity (r=0.43, p=0.02) and disability (P=0.49, p=0.017) was observed in patients with chronic non-specific low back pain. After the intervention, pain (F=14.27, p=0.001) and disability (F=5.42, p=0.03) improvement was significantly more for non-obese than obese chronic non-specific low back pain subjects.Conclusion: The results showed that obesity has a negative impact on efficacy of exercise therapy in patients with chronic non-specific low back pain. Accordingly, it seems that therapeutic approaches which target both body weight and back pain in obese patients with chronic non-specific low back pain, have more significant economic effect and even better long-term outcomes not only for pain but also for other complications associated with obesity.

Aims and Background: Based on existing scientific information, Thymus vulgaris and Matricaria chamomilla are two kinds of herbs with some anti-inflammatory effects. There are some serious side effects such as psychological dependence or blood dyscrasia subsequent to using synthetic drugs in order to treat unpleasant feeling due to Visceral pain. In order to lessen the side effects, administration of herbal medicines could be helpful. The purpose of this study is evaluating the palliative effects of hydroalcholic extracts of Thymus vulgarisand Matricaria chamomilla and their Synergistic effects on visceral pain.Materials and Methods: This experimental study was performed on 40 N-MRI male mice (36±4g) who were randomly divided into five groups: the Negative Control group treated with normal saline, Positive Control group treated with Flunixin meglumine (2 mg/kg) and the groups of Thymus vulgaris therapy (300mg/kg), Matricaria chamomilla therapy (300mg/kg) and the last one that received both Thymus and Matricaria (total 300mg/kg).These groups received drugs and hydroalcholic extracts with intraperitonial injection. The Mice were injected with acetic acid 0.6% (10ml/kg) to make visceral pain; 15 minutes after each intraperitonial administration, the palliative effects were recorded by counting the number of writhing in 30 minutes. The data was analyzed by SPSS statistical software and One-Way ANOVA (Tukey) test. The significant value was shown with (p<0.001).Findings: Co-administration of Thymus vulgaris (150 mg/kg) and Matricaria chamomilla (150 mg/kg) showed a significant reduction of pain compared to negative control group (p<0.001). But administration of Thymus vulgaris (300 mg/kg) and Matricaria chamomilla (300 mg/kg) seperately, do not induce any significant response compared to negative control group (p>0.001).Conclusion: Co-administration of Thymus vulgaris and Matricaria chamomilla can be more effective than their single administration; however further clinical studies are necessary to find a suitable place for them among other visceral analgesics.

Aims and Background: This study aimed to evaluate the structural model of the relationship between pain disposition, catastrophizing, fear of pain and pain adjustment in patients with Chronic musculoskeletal pain.Materials and Methods: 314 Patients with chronic musculoskeletal pain wete selected using convenience sampling method among clients of pain clinics in Isfahan, based on pain specialist diagnosis. They participated in the research by filling out six questionnaires: Chronic Pain Self-Efficacy Questionnaire (CPSEQ), Life-0rientation Questionnaire (LOQ), Conner-Davidson Resilience Scale (CDRS), Pain Catastrophizing Scale (PCS), Tampa Scale Kinesiophobia (TSK) and VanKroff Graded Chronic Pain Scale (CPG). Data was analyzed using structural equation modeling method.Findings: Pain disposition had a significant reverse effect on catastrophizing; besides catastrophizing had significant direct effects on fear of pain and the latter had the same effect on pain adjustment (P<0.001). Also the mediatory role of catastrophizing in relationship between disposition and fear of pain and the mediatory role of fear of pain in the relationship between catastrophizing and pain adjustment were supported.Conclusion: The results of this research show that pain disposition plays a role of Protection against catastrophizing, fear of pain, pain intensity and inability.

Aims and Background: Post operative nausea and vomiting is one of the most common complications after surgery. The newest drug for induction and maintenance of anesthesia is propofol. Its consumption due to the rapid onset, short duration of action, Anti-nausea and vomiting property and comfortable feeling after surgery is on the rise.Materials and Methods: In this clinical trial, 90 patients undergoing general surgery were randomly divided into three groups. In the first group induction-dose was 1.5 mg/kg propofol, in the second group, induction-dose was 2 mg/kg propofol and in the third group, 2.5 mg/kg propofol was used. Based on self-reporting scale and frequency of vomiting, the evaluation condidering the severity and incidence of nausea and vomiting was done in three stages: Exactly after the surgery, and 2 and 6 hours afterwards. Data was analyzed by Spss software.Findings: The results showed that considering age, gender, duration of NPO time, and operation time, no significant difference was found among the three groups. Based on one-way analysis of variance there was no significant difference between groups in severity and incidence of nausea and vomiting.Conclusion: Propofol has positive effect incontrolling nausea and vomiting after surgery in different doses. Therefore, administration of Propofol (with divided doses and without the need for pumps) is simple and cheap.