---

Background and Objective: Control of postoperative pain is one of the most important stages in the recovery of patients after surgery. This study was done to compare the effectiveness of combined Ondansetron and Apotel on the post-operative pain after surgery of upper limb fractures.
Methods: This double blind clinical trial study was done on 50 individual (41 male and 9 female) with upper limb fractures referring to 5 Azar hospital in Gorgan northern Iran during 2017. Patients were assigned (block randomization) into control and intervention groups. After the end of operation in the recovery phase, both groups received pain PCA (Patient Controlled Analgesia). In control group, the pain pump consisted of 2 grams of Apotel and in the intervention group; the pain pump consisted of 2 grams Apotel and 8 mg of ondansetron. Visual Analogue Score (VAS) was evaluated in both groups after surgery for 24 hours. Pain score of patients compared in the 2 groups during the 3 time intervals after surgery.
Results: 4 hours after upper limb fracture surgery, the mean pain was significantly decreased in the intervention group (3.20±0.707) compared to control group (3.64±0.569) (P<0.05). 12 hours after upper limb fracture surgery The Mean pain, in the intervention group (1.88±0.927) was significantly reduced in compare to control group (2.64±1.186) (P<0.05). 24 hours after upper limb fracture surgery, The Mean pain was significantly reduced in the intervention group (1.40±0.645) in compare to control group (2.08±0.997) (P<0.05).
Conclusion: This study showed that administration of compination of Apotele and Ondansetron in post-operative pain of upper limb fractures is effective than apotele alone.

---

Background and Objective: Due to the properties of herbal remedies and their lesser side effects than chemical drugs, much attention has now beeing paid to herbal treatments. The aim of this study was done to evaluate the antinociceptive and anti-inflammatory effects of hydroalcoholic extract of aerial parts of Ruscus aculeatus.
Methods: This experimental study was performed on 80 male NMRI mice (6-8 weeks) weighing 23-25 gr. Animals were randomly allocated into 5 groups including: control group (distilled water), positive control group (morphine 10 mg/kg/bw in pain test and dexamethasone 15 mg/kg/bw in inflammatory test) and three groups receiving 75, 150 and 300 mg/kg/bw Hydroalcoholic extract of Ruscus aculeatus L. The pain was evaluated by formalin test and an investigation of inflammation conducted by xylene induced ear-edema.
Results: The hydroalcoholic extract of Ruscus aculeatus L significantly reduced acute pain at 300 mg/kg/bw in compared to control group (P<0.05). Inhibition percent was 60% for acute pain and 85% in morphine group. Also, this plant caused significant reduction of formalin induced chronic pain at 150 and 300 mg/kg/bw doses in compared to the control group (P<0.05). At 150 and 300 mg/kg doses of Ruscus aculeatus L, inhibition of chronic pain was 71%, and 94%, respectively in compared with 97% inhibition in morphine group.
Conclusion: Hydroalcoholic extract of Ruscus aculeatus L at the dose of 300 mg/kg/bw reduces acute and chronic pain and at the dose of 150 mg/kg/bw reduces acute pain in laboratory animals.

---

Background and Objective: Appropriate analgesia after surgery helps patients feel more comfortable and increase the mobility of them. The purpose of this study was to compare the effect of subcutaneous injection of Ketamine and Lidocaine in reducing postoperative pain in patients undergoing elective inguinal hernia surgery under general anesthesia.
Methods: This double blinded, randomized clinical trial study was done on 60 patients undergoing elective inguinal hernia under general anesthesia. Subjects were randomly assigned into three groups including control, Ketamine and Lidocaine groups. Subjects in Ketamine group were received infiltration of subcutaneous Ketamine 0.5 mg/kg/bw after closure of surgical incision. Subjects in Lidocaine group were received infiltration of subcutaneous Lidocaine 1 mg/kg/bw at the time of wound suturing. Subjects in control group did not receive Ketamine and Lidocaine. The visual analogue scale (VAS) of pain and vital signs were continuously assessed. If VAS≥3, 100 mg diclofenac suppository was administered and if there were no response, 30 mg intravenous pethidine was also administered. The complications, including hallucination, nystagmus, nausea, vomiting and drowsiness in patients were also recorded.
Results: The mean VAS at 1, 2 hours after surgery were significantly lower in the Ketamine and Lidocaine group in compared to control group (P<0.05). No significant adverse effect was observed in the Ketamine group.
Conclusion: For reduction of pain, administration of subcutaneous Ketamine is recommended due to no adverse effect and anti analgesic effect of Ketamine is similar to Lidocaine.

---

Background and Objective: Patellofemoral pain is the most common and controversial musculoskeletal problem. Several studies have focused on its causes, prevention, and treatment strategies. This study was done to determine the effect of eight weeks of standard and functional stabilization training on pain and functional movement of women with patellofemoral pain.
Methods: This quasi-experimental study was performed on 45 non-athletic women with patellofemoral pain syndrome aged 18-35 years. Subjects were divided into three standard, functional stabilization training and the control group and followed for 8 weeks. Pain was measured by visual analogue scale and functional movement was measured by the KUJALA (Anterior knee Pain Scale).
Results: Severity of pain significantly reduced in the two interventional groups (standard and functional stabilization training) in comparison with control group (P<0.05). Functional movement significantly increased in the two interventional groups in comparison with control group (P<0.05). Severity of pain and functional movement had no significant difference between the two intervention groups.
Conclusion: Performing each of the exercises, standard or functional stabilization training, for eight weeks, had beneficial effect on reducing pain and improving functional movement in patients with patellofemoral pain syndrome.

---

Background and Objective: Pain after tonsillectomy is one of the most common complications. This study was done to compare the effect of Gabapentin and promethazine as premedication to reduce pain after tonsillectomy.
Methods: This clinical trial study was performed on 104 patients aged 7-15 years who were candidate for tonsillectomy. Patients were randomly divided into gabapentin and promethazine groups. The first group received oral gabapentin 20 mg/kg/bw, and the second group was treated with promethazine syrup 0.5 mg/kg/bw one hour before anesthesia. Pain score was recorded based on the MOPS index and recorded and compared during 3, 6, 12, and 24 hours after surgery.
Results: The mean±SD of pain severity in the intervention group with promethazine at 3, 6, 12 and 24 hours after surgery were 1.35±0.84, 0.9±0.87, 0.25±0.52, 0.04±0.19, respectively. Pain severity was 1.58±0.98, 1.13±0.91, 0.69±0.27, and 0.06±0.24 in gabapentin group, respectively. There was no significant difference between pain score of two groups in 3, 6, 12 and 24 hours after surgery.
Conclusion: Gabapentin and promethazine as premedication have a similar analgesic effect in patients after tonsillectomy.

---

Background and Objective: Vitamin deficiency is common in patients with chronic low back pain and is one of the most important risk factors for chronic kidney disease. The aim of this study was to evaluate the effect of one course of core stabilization exercise and vitamin D intake on some of renal function biomarkers in patients with chronic back pain.
Methods: This single-blind clinical trial study was done on 48 women with chronic low back pain with random assignment in 4 groups of 12 people including control, exercise, vitamin D and combined groups. The exercise and combined groups performed 8 weeks of core stabilizing exercises with different levels. The vitamin D and combined groups received 50,000 IU vitamin D/week. Creatinine, urea and uric acid levels were measured before and after the interventions.
Results: The results showed that 74.26% and 25.64% of the patients had deficiency and insufficiency of vitamin D, respectively. After 8 weeks, significant reduction was observed in creatinine, urea and uric acid indicators of the exercise, vitamin D and combined groups (P˂0.05). In addition, combined intervention induced more reduction in mean of urea, and uric acid levels in compared to the two other interventions but the effect of exercise on the reduction of uric acid was more than vitamin D intake (P˂0.05).
Conclusion: Both core stabilization exercises and vitamin D intake intervention can be effective in improving renal function in chronic low back pain patients having abnormal low vitamin D levels. On the other hand the combined intervention seems to have more effectiveness.

---

Background and Objective: Alteration of scapular position and motion are called scapular dyskinesis (SD), that leads to symptoms such as pain in the shoulder joint. This study was performed to determine the effect of eight weeks scapular stabilization exercises on shoulder pain of archer men with scapular dyskinesis.
Methods: In this clinical trial study 30 archer men of recurve sport field with SD and shoulder pain were randomly divided into two intervention and control groups. Shoulder pain of all subjects was evaluated by using numeric pain rating scale. Then the interventional groups were received scapular stabilization exercises in three sessions per week for eight weeks. The control group performed only their normal daily exercises. At the end of the training, post-test was performed for both groups.
Results: The results of the present study showed that after scapular stabilization exercises, the reduction of dominant shoulder pain both during exercise and at rest was significant in interventional group in compared to controls (P<0.05). But in Non-dominant shoulder, there was significant effect in pain reduction only in intergroup (P<0.05) and there was no significant effect between interventional and control groups.
Conclusion: Scapular stabilization exercises can use to reduce the pain of dominant shoulder joint of archer sport men with scapular dyskinesis.

---

Background and Objective: Back pain is a common orthopedic disease that affects up to 80% of the population at some point in life. Brace is one of the tools that used to reduce pain. The relationship between brace application and gait parameters in people with low back pain is not well understood. This study was done to determine the effects of simple and sensor thoracolumbosacral braces on gait kinetics in patients with low back pain.
Methods: This quasi-experimental study was performed on 15 men and women with low back pain in the biomechanics laboratory of Mohaghegh Ardabili University Health Center in nort-west of Iran during 2020. Each participant performed three gait conditions including without brace, with sensory brace and with simple brace. Ground reaction forces were recorded and compared by a force plate while walking.
Results: The average walking speed during no brace, simple brace and sensor braces were not significant different. Also, results did not demonstrate any significant effect of simple or sensor braces on ground reaction force amplitudes, their time to peak, and free moment values.
Conclusion: Simple and sensory thoracolumbosacral brace did not effect on gait kinetics in low back patients.

---

Background and Objective: The scientific evidence related to the effectiveness of rehabilitation on electromyographical activity of trunk muscles is limited. This study was performed to determine the effect of movement-pattern training on frequency of selected trunk muscles during single-leg landing in individuals with non-specific chronic low back pain.
Methods: In this clinical trial study, 28 patients with non-specific chronic low back pain were randomly divided into intervention and control groups. The control group did not receive treatment. The intervention group performed treatment as a movement-pattern training. Subjects performed single leg landing from 30 cm height. Trunk muscle activity was assessed using an 8-chanel EMG system. The assessments were completed in pre-test and after six weeks.
Results: Frequency content of right rectus abdominus and right lumbar erector spinae in intervention group were lower than control group (P<0.05). In other muscles ant there was not any significant significant differences between interventional and control groups.
Conclusion: The movement-pattern training can be used in rehabilitation of individuals with non-specific chronic low back pain.

---

Background and Objective: Propofol is one of the most commonly used drugs in anesthesia with the pain during an injection is a side effect of this drug. This study was conducted to compare the effect of Lidocaine, Magnesium Sulfate, and Ketamine on reducing pain caused by intravenous injection of Propofol in patients Undergoing surgery.
Methods: In this double-blind randomized clinical trial study, 80 patients aged 18 to 65 years were randomly blocked and assigned into four groups including Lidocaine, Ketamine, Magnesium Sulfate and Normal Saline. The pain was measured with the Ambesh Score. Hemodynamic changes of patients were evaluated in 1, 3, and 5 minutes.
Results: The patients in Lidocaine, Ketamine, and Magnesium Sulfate groups with 75%, 70%, and 55%, respectively, did not feel pain after Propofol injection compared to Normal Saline group (25%) (P<0.05). The mean time trend of Systolic and diastolic blood pressure and mean arterial blood pressure between the studied groups were significant (P<0.05).
Conclusion: The use of Lidocaine or Ketamine during Propofol injection can be effective in reducing pain during injection in patients undergo surgery.

---

Background and Objective: Chronic use of opioids leads to analgesic tolerance. Protein kinase C (PKC), adenylyl cyclase (AC), nitric oxide (NO) and glycogen synthase kinase 3 beta (GSK-3β) are involved in morphine tolerance. Lithium activates the phosphatidylinositol 3 kinase (PI3K)/protein kinase B (AKT) pathway that inhibits GSK-3β and reduces morphine-induced tolerance. This study was performed to evaluate the effects of lithium on morphine dependence symptoms and tolerance of its analgesic effects in Swiss mice by GSK-3β signaling.
Methods: This experimental study was performed on 56 Swiss male albino mice that were randomly allocated into 8 groups (each containing 7 mice). The intraperitoneal injection of morphine at different concentrations (50, 50 and 75 mg/kg) and different hours (08:00, 11:00 and 16:00, respectively) was performed for 4 days, and a single dose 50 mg/kg was administered on the 5th day. The effects of three doses of lithium (1, 5 and 10 mg/kg) given orally, 45 min before morphine injections on morphine-induced analgesic tolerance were evaluated. To evaluate analgesia latency on day 1, 3 and 5, tail flick and hot plate tests were done. The brain of each animal was removed to measure nitrite levels, and histological evaluation and immunohistochemistry for p-glycogen synthase (p-GSSer640) were performed on the last day of the study.
Results: Co-administration of lithium significantly increased the latency of analgesia in comparison with the morphine group on the 3rd and 5th day (P<0.05). Lithium reduced the morphine-induced increase of nitrite levels and also reduced brain damage. In addition, immunohistochemistry assay of p-GSSer640 indicated a significant reduction of the morphine-induced phosphorylation of GS at S640 by GSK in the lithium-treated mice.
Conclusion: Lithium administration can reduce morphine tolerance in adult male Swiss mice.

---

Background and Objective: Neuropathic pain is a large and difficult group of peripheral nerve diseases, which are complicated to treat. This study was designed to determine the effectiveness of acceptance and commitment therapy (ACT) on psychological well-being and pain perception among patients with chronic neuropathic pain.
Methods: This clinical trial was performed on 30 patients with chronic neuropathic pain who were referred to the Rohani Hospital and private clinic of a neurologist in Babol (Iran) in 2022. The patients were randomly divided into an interventional and a control group. The patients completed the psychological well-being scale (Ryff) and pain belief and perception inventory (Williams and Thorn) in the pretest. Then, ACT (120 minutes) was performed for the interventional group, 8 sessions a week. The patients completed the scales after the treatment course and 2 months after the posttest.
Results: In the first follow-up, there were significant differences between the two groups in terms of total score of psychological well-being (P<0.05), the subscales of self-acceptance (P<0.05), positive relationships with others (P<0.05), autonomy (P<0.05), environmental mastery (P<0.05), purpose in life (P<0.05), personal growth (P<0.05), the total score of pain perception (P<0.05), the subscales of belief in the stability of pain in the present (P<0.05) and belief in the mysteriousness of pain (P<0.05). The treatment results were maintained in the second follow-up phase. In the first follow-up, the subscales of belief in the continuation of pain in the future and belief in self-blame did not differ significantly between the two groups, but in the second follow-up, the subscales of belief in the continuation of pain in the future (P<0.05) and belief in self–blame (P<0.05) differed significantly between the two groups. In addition, the average psychological well-being in the intervention group was higher than that in the control group, and the average pain perception in the intervention group was lower than that in the control group.
Conclusion: This study shows the ACT could be an effective intervention for improving psychological well-being and pain perception among patients with chronic neuropathic pain.
 

---

Background and Objective: Long-standing groin pain (LSGP) is a common injury in ball games. This study aimed to compare the electrical activity of selected lumbopelvic-hip muscles during a single leg jump-cut maneuver in football players with LSGP and healthy players.
Methods: In this case-control study, 32 football players were divided into two groups: LSGP (n=16) and healthy (n=16). A force plate was used to determine the heel-contact and heel-off moment. The ground reaction forces and the average of three trials of the electrical activity of selected lumbopelvic-hip muscles during a single leg jump-cut maneuver were recorded bilaterally.
Results: At the heel-contact moment, the rectus abdominis and adductor longus muscles on the dominant side and the multifidus muscle on the opposite side showed significantly higher activity in the LSGP group compared to the healthy group (P<0.05). Similarly, at the peak of the vertical reaction force, the rectus abdominis and adductor longus muscles on the dominant side and the multifidus and gluteus medius muscles on the opposite side were significantly more active in the LSGP group (P<0.05). At the toe-off moment, the internal oblique, adductor longus, and gluteus medius muscles on the dominant side and the internal oblique, multifidus, and gluteus medius muscles on the opposite side were also more active in the LSGP group compared to the control group (P<0.05).
Conclusion: Long-standing groin pain causes changes in the electrical activity of muscle groups during different phases of the single-leg jump-cut maneuver, leading to increased dynamic stability and possibly an increased risk of overuse injuries, chronic injuries, economic consequences, and exclusion from sports activities.
 

---

Unusual chest pain is often observed in older women with diabetes, high blood pressure, and heart disease. Some unusual manifestations of myocardial infarction have so far been reported, including earache, flank pain, fatigue, neck pain, nausea and vomiting, shortness of breath, and shoulder pain. In this article, we report a case of rare symptoms of cardiovascular disease with referral symptoms, including abdominal colic pain. The patient was a 55-year-old man with a history of diabetes under treatment with insulin who had abdominal colic pain, periodic epigastric tenderness, and frequent nausea and vomiting for 2 days. At first, he was suspected of pancreatitis, but considering that his amylase and lipase enzymes were normal and no evidence of the existence of free abdominal and pelvic fluid was observed according to ultrasound results, the hypothesis of pancreatitis was rejected. Despite the normality of the initial ECG until the night before the visit by the cardiologist, the patient experienced more severe pain and, as a result, was referred to the cardiac internal ward until the end of the same night, after angiography, it was found that the obtuse marginal (OM1) branch of coronary arteries had severe narrowing (90-99%). Abdominal tenderness and colic pain are among the unusual manifestations of myocardial infarction. In patients with cardiac risk factors, such as diabetes and chronic kidney disease, despite the existence of a normal ECG, uncommon manifestations should be checked.

---

Background and Objective: Neck pain is a prevalent problem negatively affecting individuals’ health and quality of life. Therefore, the present research was conducted to determine the impacts of neck stabilization and thoracic mobility exercises on disability, range of motion, and endurance of females with non-specific chronic neck pain.
Methods: This single-blinded clinical trial was conducted on 36 females with non-specific chronic neck pain in three 12-people groups in the city of Qom. The subjects of the first intervention group (those doing neck stabilization exercises) and the second intervention group (those doing neck stabilization exercises with thoracic mobility) performed the exercises as three 60-minute sessions per week for 8 weeks in the gym, and the control group received a set of corrective exercises. Disability, the neck range of motion, and muscular endurance were measured by the Neck Disability Index (NDI), goniometer and the Progressive Iso-inertial Lifting Evaluation (PILE) test, and biofeedback sphygmomanometer, respectively.
Results: Disability, range of motion, and muscular endurance of the subjects in both intervention groups significantly improved compared to the control group (P<0.05). Compared to the first intervention group, the range of motion and muscular endurance of subjects in the second intervention group showed a significant improvement (P<0.05).
Conclusion: Doing neck stabilization and thoracic mobilization exercises was found to be an influential intervention in the improvement of disability, range of motion, and muscular endurance of females with non-specific chronic neck pain.

---

Background and Objective: The psychological experience of mental pain can lead to distress similar to that caused by actual injury or trauma. As such, it poses a life-threatening consequence for chronic patients, although it is rarely assessed and treated in clinical settings. One of the diseases associated with high levels of physical and mental pain is the rare disorder neurofibromatosis. This study aimed to evaluate mental pain in patients with neurofibromatosis and its association with disease severity.
Methods: This descriptive-analytical study was conducted on 207 patients with neurofibromatosis who were members of the Iranian Neurofibromatosis Support Association during 2023. Data collection tools included a demographic and clinical information registration form and the Orbach and Mikulincer Mental Pain Scale (OMMP), which comprises 44 items and 6 subscales, with a scoring range from 44 to 220.
Results: The total mental pain score was 121.15±42.41, with a range of 44 to 206. The total mental pain scores for men and women were 123.67±38.98 and 120.31±43.58, respectively. The "confusion" subscale had the highest average score, while the "fear of loneliness" subscale had the lowest average score. There was a statistically significant association between the total mental pain score and its subscales with the severity of the disease and the patient's educational level (P<0.05).
Conclusion: The mental pain scores of patients with neurofibromatosis were evaluated to be relatively unfavorable.

---

Background and Objective: Restrictions imposed during the coronavirus disease 2019 (COVID-19) pandemic led to a decrease in physical activity levels across various age groups, particularly among students. This study aimed to determine the effect of eight weeks of corrective exercises on musculoskeletal pain levels in 13-15-year-old students.
Methods: This clinical trial was conducted on 101 students (44 girls and 57 boys) aged 13 to 15 experiencing musculoskeletal pain in various body parts in Bandar Mahshahr, Khuzestan Province, during the second half of the academic year 2021-2022. Participants were selected based on the Adolescent Nordic Musculoskeletal Questionnaire (NMQ), considering only the first question regarding the presence or absence of pain in each of the nine body regions (neck, shoulder, elbow, hand, upper back, lower back, pelvis, knee, and ankle) in the past seven days. A score of 1 was assigned to the presence of pain and 0 to the absence of pain. Participants were randomly assigned to two groups of 60: A control group and an intervention group. The intervention group performed corrective exercises at home for eight weeks, with three sessions per week, each lasting 40 minutes. No intervention was provided to the control group. Musculoskeletal pain levels in the neck, shoulder, upper back, elbow-arm, wrist, lower back, knee, and ankle were then compared in the pre-test, post-test, and follow-up.
Results: The mean and standard deviation of the total pain scores for the intervention and control groups were 1.32±0.41 and 1.33±0.46 in the pre-test, 1.01±0.08 and 1.34±0.46 at the post-test, and 1.17±0.36 and 1.11±0.31 at follow-up, respectively. Results revealed that eight weeks of corrective exercises significantly reduced musculoskeletal pain levels in the students’ neck, shoulder, upper and lower back, elbow, knee, wrist, ankle, pelvis, and thigh (P<0.05); however, this improvement was not sustained at the follow-up.
Conclusion: Performing corrective exercises reduced musculoskeletal pain levels in the neck, shoulder, upper and lower back, elbow, knee, wrist, ankle, and pelvis and thigh of 13-15-year-old students; however, the benefits were not sustained when the exercises were stopped.

---

Background and Objective: Patellofemoral pain syndrome (PFPS) is among the common causes of anterior knee pain in adolescents and individuals under 60 years of age. This study was conducted to determine the effect of closed kinetic chain exercises on changes in plantar foot pressure dynamics in women with PFPS.
Methods: This quasi-experimental study was conducted on 30 female university students aged 20 to 35 divided into two groups of 15 (one group diagnosed with PFPS and a healthy control group) at Mohaghegh Ardabili University in 2023. The PFPS group had a pain history of at least two months to a maximum of one year. The experimental group performed closed kinetic chain exercises three times a week for eight weeks. Plantar foot pressure variables were measured using a pressure foot scanner (sampling rate of 300 Hz).
Results: The peak forces in the first toe during slow-speed running exhibited a statistically significant decrease in both the healthy group (64.91 ± 28.69) and the PFPS group (215.19 ± 60.28). Furthermore, the time to reach the peak ground reaction force in the PFPS group (49.65 ± 44.332) showed a statistically significant increase during the post-test at slow-speed running (P<0.05). The external heel force (153.97±3.62) and the fifth metatarsal bone (65.19±19.77) in the healthy group demonstrated a statistically significant reduction in the post-test compared to the PFPS group during fast-speed running (P<0.05). In both the healthy and PFPS groups, statistically significant decreases were observed in the post-test for center of pressure (COP) displacement variables in the mediolateral and anteroposterior directions during both slow-speed and fast-speed running (P<0.05). Additionally, in the healthy group, a statistically significant reduction was found in the post-test for COP displacement at the first toe (64.5±51.08) during fast-speed running (P<0.05).
Conclusion: Closed kinetic chain exercises lead to a statistically significant reduction in plantar foot pressure variables in women with PFPS and healthy women.