Background: Treatment of major depression is crucial to decrease the burden of disease. Hence, in this study, theefficacy of Botox was compared with placebo for treatment of patients with major depression.Methods: In this randomized clinical trial, 28 consecutive patients with major depression were enrolled. The patientswere randomly assigned to receive either Botox or placebo and the scores of Beck Depression Inventory were determinedand compared at baseline and after two and six weeks in the groups and between the groups. In addition, thedrug adverse effects were compared between groups. This study had been registered in TCTR withTCTR20170409001 code.Results: There was a statistically significant difference two group for 6th week Beck Score (P=0.004), but at baselineand after two weeks, there was no significant difference (P>0.05). None of the patients experienced side effects.Conclusion: Finally, Botox is effective for treatment of patients with major depression and it has a high safety

Based on the conducted anatomic studies at our institutions as well as clinical experience with migraine surgery, we have refined our onobotulinumtoxin A (Botoxâ) injection techniques. Pain management physicians are in unique position to be able to not only treat migraine patient, but also to be able to collaborate with neurologists and peripheral nerve surgeons in identifying the migraine trigger sites prior to surgical deactivation.The constellation of migraine symptoms that aid in identifying the migraine trigger sites, the potential pathophysiology of each trigger site, the effective methods of botulinumtoxin and nerve block injection for diagnostic and treatment purposes, as well as the pitfalls and potential complications, will be addressed and discussed in this paper.

Background: Pain is the most common postoperative complication of hemorrhoidectomy. We evaluated the effectiveness of intrasphincteric Botox injection on posthemorrhoidectomy complications including pain reduction and wound healing. Materials and Methods: In this randomized, double‑ blind clinical trial, patients with Grades 3 or 4 symptomatic hemorrhoids who underwent open (Milligan‑ Morgan) hemorrhoidectomy were enrolled. The experimental group received intrasphincteric Botox injection during hemorrhoidectomy, while the controls received normal saline injection. Hemorrhoid grades, constipation status, history of hemorrhoidectomy, duration of operation, pain at rest and after defecation in six follow‑ up periods (6, 12, 24, and 48 h and 7 and 14 days after operation), wound healing (during follow‑ up after discharge with a 2‑ week period), analgesic use, and Botox side effects were evaluated and compared in the two experimental and control groups. Results: In this trial, 34 and 33 patients were randomly allocated in the experimental and control groups, respectively. Operation time was significantly higher in Botox group (P = 0. 009). Mean dose of analgesics use in Botox was significantly lower (P < 0. 001). Rate of wound healing during follow‑ ups was significantly higher in Botox group in the fifth follow‑ up (P = 0. 009). Frequency of urinary retention (P = 0. 02) and moderate itching (P = 0. 01) was significantly higher in placebo than Botox group. Mean of postoperative pain at rest in Botox group was significantly lower at 12th, 24th, and 48th h and 7th and 14th days after operation (P < 0. 01). Mean of postoperative pain in Botox group was significantly lower at 3rd to 5th defecation (P < 0. 01). Conclusion: Our findings indicated that a single‑ dose injection of Botox during Milligan‑ Morgan hemorrhoidectomy is associated with less postsurgical pain at rest and during defecation and improved wound healing. It is suggested that it is a safe and effective procedure during hemorrhoidectomy regarding the procedure‑ related complications.