فصلنامه بیهوشی و درد
سال نهم شماره 3 (پاییز 1397)

Aims and background: chronic pain isn’t always psychosomatic. Chronic pain, is a disorder that has a lot of psychological components and onethat a lot of people have at some point in their life. The aim of this study was to determine the role meta-cognitive beliefs play in mediating between alexithymia and the intensity of pain that is perceived percipience by the patients with chronic pain. This study evaluated patients aged 20-60 with chronic pain who had been referred to the Mahan clinic and the physical medicine and rehabilitation clinic of Arman in Tehran from the spring of 1396 to autumn of 1396. During this time frame 440 patients who had at least 3 months of musculoskeletal pain, were chosen. Theyanswered the Toronto Alexithymia Scale (TAS-20) the Meta-cognition Questionnaire (MCQ-30), and the Numeric Rating Scale (NRS). Findings: The intensity of pain was coorelated positively with with alexithymia (p< 0.001) and meta-cognitive beliefs (p< 0.001). Alexithymia had a positive coorelationwith meta-cognitive beliefs (p< 0.001). Alexithymia (t=6.68, β= 0.29), and meta-cognitive beliefs (t= 2.42, β= 0.11) could clarify the variance of the pain intensity. Alexithymia could also clarify the meta-cognitive beliefs (t= 9.48, β= 0.40). Based on the findings, the relation between alexithymia and the intensity of pain, was not a simple linear relationship, but meta-cognitive beliefs, could affect this relationship.

Aims and Anterior cruciate ligament injury is the most common ligament injury of the lower limb that necessitates reconstruction as a proper treatment approach. It is now up to the researchers to ask, are the altered kinematic patterns in the lower limbs corrected by this reconstruction? The present study aims to analyze the range of motion and angular velocity of the lower limb joints in patients with reconstructed Anterior cruciate ligaments during landing. 20 male subjects who participated voluntarily were divided into 2 groups. One group consisted of healthy subjects (control) the other of patients with reconstructed Anterior cruciate ligament (experimental). They were evaluated in 3 assignments: landing from a box, a vertical jump-landing, and a jump from an obstacle-landing. 3-Dimensional kinematics of the range of motion and angular velocity of the lower limb joints were recorded using 4 cameras and processed by visual 3D software. Findings: In the sagittal plane, the experimental group’s knee and hip joints range of motion was less than the control group (p=0.00) The ankle joint was more (p≤0.05) than the control group. In per 3 planes, the experimental group’s ankle and knee joints angular velocity was lower than the control group. The hip joint was higher than the control group (p≤0.05). In most cases, both variables showed the smallest value in the landing from the box task and the highest value in the jump from obstacle-landing task (p≤0.05). During complex tasks such as landing, patients exhibit altered kinematic patterns that are followed by compensatory mechanisms in adjacent joints. These altered patterns will persist for at least 2 years after the Anterior cruciate ligament is reconstructed. These patients, in the absence of care, are at risk for Anterior cruciate ligament re-injury and prone to develop knee osteoarthritis in future.

Aims and background: The aim of this study was to determine the effects of isolated and combined use of valgus knee braces and lateral wedge foot orthotics on the frequency spectrum of ground reaction forces generated in the knee by the gait of patients with knee osteoarthritis. 24 males (age: 62.1 ± 2.0 years( with varus knee malalignment and symptomatic medial compartment knee osteoarthritis participated in this study. Subjects walked over ground at their preferred speed in four conditions: (1( no assistive device (control(; (2( using lateral wedges, (3( using knee braces, and (4( using both lateral wedges and knee braces. The frequency spectrum of ground reaction force was calculated during walking in these different conditions. Findings: The ground reaction force requency was lower, with a power of 99.5%, in the vertical direction when the lateral wedges were used than those generated with walking with no assistive devices on both limbs. Also with use of the lateral wedge plus the brace this freqency was lower than that generated during walking with no assistive devices on both limbs. The results of the present study demonstrated that combined use of laterl wedge and valgus knee brace reduced ground reaction force frequency better than using these interventions seperately.

Aims and background: Labor pain is often severe. Unrelieved labor pain can have an adverse effect on the physiologic status of the women in labor. Accurate measurement and appropriate management of pain is a significant problem for attending medical and nursing personnel. There are several options for controlling labor pain. Each method has its own risks and benefits, with variations in effectiveness, availability and acceptability. The purpose of this study was to compare the effectiveness of remifentanil when used with and without dexamethasone in women undergoing a normal vaginal delivery.

In this study 90 pregnant women were selected from the pregnant women referred to Alavi Hospital. Group A received Remifentanil with Dexamethasone and Group B received Remifentanil alone. The pain scores based on VAS were measured before the intervention and 30, 60, and 120 minutes after the intervention. Finally, the data were analyzed by SPSS. Findings: Pain severity according to the VAS score was significantly lower in patients that received remifentanil with dexamethasone 30, 60 and 120 min after the intervention compared to the other group. Analysis of the pooled risk differences showed that nausea, vomiting and headache were significantly higher in remifentanil alone users. There wasn’t a significant difference in FHR or Apgar in the 1st and 5th minute between the two groups.

The use of remifentanil with dexamethasone has more of a beneficial effect for many parturient women compared to remifentanil.

Aims and

Optomizing Women’s health should be one of the main goals of social and economic development of a society. The purpose of this study was to determine the efficacy of mindfulness-based stress reduction on the severity of symptoms and pain-catastrophizing in students with premenstrual dysphoric disorder.

The method of this study was a pre-test, post-test, and control group with a follow-up period of 45 days. 370 subjects were selected by available sampling methods from the students of Isfahan Islamic Azad University (Khorasgan) and were screened with a Premenstrual Symptoms Screening Tool (PSST). 30 who were found to have premenstrual dysphoria and were randomly assigned to either the test or control group. The instruments used for measuring symptoms were a daily Record of Severity of Problems and the Pain Catastrophizing Scale. The experimental group received treatment consisting of 8 sessions of 90 minutes of mindfulness-based stress reduction. No intervention was performed on the control group. The data was analyzed by SPSS-22 software, using multivariate analysis of covariance analysis. Findings: The treatment of mindfulness-based stress reduction had a significant effect on symptoms (physical and psychological) and pain-catasrophizing (rumination, magnification and helplessness) in post-test and follow up of 45 days (P >0.01).

Mindfulness-based stress reduction is an effective treatment to improve the severity of symptoms and Pain-Catasrophizing of Premenstrual Dyhsphoric Disorder.

Aims and background: A major surgery such as a laparotomy can induce severe pain in a patient. However administration of pain control medications can have dramatic effects on the hemodynamic status of the patient. Therefore, the aim of this study was to investigate intravenous infusion of magnesium sulfate for pain control and its’ effect on the hemodynamic status of the patient after laparotomy surgery. In this clinical trial , 80 patients undergoing laparotomy surgery were randomly classified into intervention and control groups based on exclusion and inclusion criteria. The intervention group received a bolus of magnesium sulfate 50 mg /kg half an hour before surgery, and then an infusion of 500 mg /hr. for 24 hours after surgery. P <0.05 was considered significant. Findings: No significant difference was seen before and after surgery between the intervention and control groups regarding hemodynamic status or pain severity up to 6 hours after surgery. However by 6 hours after surgery, the severity of pain in the intervention group was lower than in the control group. This difference was statistically significant (P = 0.01). Magnesium sulfate has little effect on the hemodynamics of the patients undergoing surgery, but also was not effective for the control of pain in the first hours after surgery However six hours after surgery a pain control effect was noted

Aims and background: Muscle trigger points are one of the main sites of chronic pain in the musculoskeletal system. The activity of the trigger points of the quadrates lamborum muscles are a very common cause of low back pain. Therefore, the purpose of this study was to investigate the effect of Physical therapy with and without Positional Release Techniques on the pain, disability and range of motion of patients with chronic low back pain. The target population was people who had chronic back pain in the trigger points in the lumbar muscles. Patients were randomly divided into two groups. The first group received Physical therapy with Positional Release Techniques and the second group, received only standard Physical therapy. Each group received 12 sessions of treatment over a period of three weeks. Pain was assessed before and after treatment by a Visual analogue scale (VAS) and the OSWESTRY disability questionnaire. Range of motion at the waist was evaluated by Schuber’s adjusted test both before and 48 hours after treatment. ANOVA with repeated measures was employed for data analyses and the results were considered significant if p<0.05. Findings: There was a significant difference in pain severity, the disability index and lumbar range of motion after intervention in both groups compared to pre-therapy levels. (P >0.005). Analysis of the two different treatment groups also showed there was a significant difference in the severity of pain, the disability index and lumbar range of motion (P >0.005), improvements that were achieved in the Physical therapy with Positional Release Technique group compared to the physical therapy alone group. Physical therapy in two situations with and without Positional Release Technique is effective in reducing pain and improving the lumbar motion in patients with chronic low back pain. Physical therapy combined with Positional Release Technique was more effective in reducing pain, the disability index and increasing the lumbar range of motion compared with the standard Physical therapy group

Aims and background: Patients with migraine have been shown to have a high rate of psychological comorbidities such as depression, anxiety and stress. The aim of the paper was to study the effectiveness of migraine specific psychotherapy on the patents’ ratings of their psychological problems. In this semi-experimental study with a pretest-posttest control group, 30 migraine patients were selected from Khatam-ol-Anbia hospital in Zahedan and randomly assigned into an experimental or a control group. The experimental group received special psychotherapy for migraine patients during 8 sessions of 2.5 hours each. The control group did not receive any intervention during the study period. Experiment and control groups completed the Depression Anxiety Stress scale )DASS_21( before and after the intervention. Data was analyzed by MANCOVA test using SPSS18. Findings: The results of the data analysis showed that there was a significant difference between the mean scores of depression, anxiety and stress before and after treatment (p < 0.001). Therefore, the migraine specific psychotherapy was effective in decreasing the measurements of the of patents’ psychological problems. The migraine specific psychotherapy is effective in reducing psychological problem scores of migraine patents. Therefore, it is recommended as an effective therapy to improve mental health