فصلنامه بیهوشی و درد
سال دهم شماره 2 (تابستان 1398)

The low back pain is a highly prevalent in all societies, with the majority of people experiencing back pain at least once in their lifetime. If a definite diagnosis of low back pain is not detectable by recent radiological instruments, it is classified as chronic low back pain. This study evaluates the relationship between pain and functional disability with the level of activity of the trunk muscles and comparison the activity of these muscles in men and women. forty-seven strength-training athletes (25 female, 22 male) with non-specific chronic low back pain were selected to participate in this study. Surface electromyography device was used to record the activity of Multifidus muscle, Erector Spine, Transverse abdominal, Rectus abdominis. All statical analyses were performed using SPSS statical sotware version 20 and Pearson correlation method to determine the relationship between pain and functional disability with muscle activity and independent t-test to compare the activity of these muscles in men and women, and the significant level was set at 0.05. The results of Pearson correlation showed that there was a reverse and significant correlation between local trunk muscle activity and pain and functional disability, and there was no significant difference in the level of local and trunk global trunk muscle activity between men and women with chronic low back pain (p>0.05). The results of this study showed that the activity of local muscles decreased and as a results pain and functional disability increased in low back pain patient. This situation leads to spinal instability. Therefore, local muscles should be strengthened in rehabilitation process.

The aim of this study was to investigate effects of backward gait training on Excursions of Lower Limb Joints in man Patients with medial knee Osteoarthritis. The subjects were 21 healthy men and 42 male patients with knee osteoarthritis who were divided into experimental and control groups according to the Kellgren and Lawrence radiologic scale and the visual analogue scale. The experimental group performed backward gait training for six weeks. A Vicon (130 Hz) motion analysis system with four T-Series cameras were used to measure parameters by Vicon Nexus 1.8.5, Polygon 4.1.2 software. There were no significant differences in all kinematics parameters (joint angles) between the healthy and KOA groups (P>0.05). There were significant differences observed between groups of patients and healthy subjects (patients & health) for knee flexion/extension excursion (P=0.014, P=0.047), hip Internal/external rotation excursion (P=0.014, P=0.047) and the visual analogue scale(P=0.00, P=0.00) Significant influence of exercise on increasing the rate of anterior/posterior pelvic tilt the experimental group compared with control groups (P=0.028, P=0.026). There were significant differences observed between groups of control and intervention for the visual analogue scale. Some of the observed changes in kinematics parameters are due to effects of compensatory mechanisms, and some of them might be considered as the severity of the OA. In addition, OA in one joint had strong effects on other joints. Backward gait training protocol had a significant effect on knee/ hip excursions and reduction of pain.

Delirium is a common postoperative complication in adolescence patients and is associated with increased costs, morbidity and mortality. Recently, an association between the occurrence of delirium and increased risk of dementia has been revealed. Several risk factors have been found to be related with the development of postoperative delirium. However, the three strategies include monitoring depth of anesthesia, adequate pain assessment and treatment, immediately diagnosing postoperative delirium are highly recommended.

The purpose of this study was to investigate the effect of a session of suspended exercise using a tool designed for pain and characteristic of intervertebral disc of the lumbar vertebrae. This is a quasi-experimental study with a pretest-posttest design. The subjects consisted of 12 men with chronic low back pain caused by lumbar disc herniation in L4-L5 and L5-S1 regions. After assessing the degree of pain using Visual Analog Scale and determining the structural characteristic of intervertebral by using magnetic imaging resonance, the subjects performed suspension exercises using the designed chair over a 30-min session. At the end of session, the pain and disc herniation of discs were re-assessed. For data analysis, the paired t-test and Wilcoxon tests were applied at a significant level of p≤0.05.  The results indicated significant changes in the degree of pain in the pre and post-test stages, so that a remarkable pain relief was observed in the post-test. In relation to the structural characteristics of the intervertebral disc, despite the apparent changes in the mean of collected data, the results did not reveal any significant change between pretest and posttest. Considering the beneficial effects of the designed device with respect to pain alleviation and thus reduced using of sedatives and anti-inflammatory drugs, this method can be helpful at the early treatment stages for chronic pains.

Fibromyalgia is a chronic disabling syndrome and characterized by widespread multilateral musculoskeletal pain, with multiple points and unstable tender that is followed by some Psychological variables. Therefore, the aim of the present study was the effectiveness of therapy based on quality of life promotion model on pain catastrophizing in female patients with fibromyalgia. The present study was semi-experimental study with pre-test and post-test design with the control group and follow-up. The study statistical population included all women with fibromyalgia referring to private clinic of rheumatology specialists in Shiraz city whoem 30 patients  with available sampling  were selected and randomly were divided into two groups of experimental (15 persons) and control (15 persons). Research tool included catastrophizing scale (PCS) which participants completed in pre- test, post- test and follow-up. Descriptive statistical methods and Analysis variance with repeated measures were used. The results showed that therapy based on quality of life promotion was effective in reducing pain catastrophizing in patients. Using Psychological therapies can help patients with fibromyalgia for reducing pain catastrophizing.

Knee osteoarthritis (OA) is a major public health issue because it causes chronic pain, reduces physical function and diminishes quality of life. Knee osteoarthritis is a chronic disease and is one of the most common causes of disability in the elderly. Population ageing and increased global prevalence of obesity are anticipated to dramatically increase the prevalence of knee OA and its associated impairments. Because of direct and indirect costs, it is costly for patients and community. No definitive treatment for knee osteoarthritis is known, but prolotherapy is a complementary injecting drug for chronic muscular pain, including knee osteoarthritis, which is used to stimulate repair of soft tissue and decrease the pain associated with chronic soft tissue damage. Therefore, the present study was conducted to evaluate various prolotherapy methods for the treatment of patients with knee osteoarthritis. A systematic literature search was conducted in five medical electronic databases, PubMed, Scopus, Medline, Cochrane Collaboration and Google Scholar, up until April 2018. We included randomized controlled trials and quasi-randomized controlled trials (where the allocation is not strictly random (comparing dextrose with erythropoietin, platelet-rich plasma and radiofrequency for osteoarthritis of the knee in adults. Risk of bias analysis and best evidence synthesis were performed. The main aspects related to treatment were analyzed: decrease in pain level, stiffness, physical function and range of motion. Two clinical trials including 112 patients were included in this study. The results analysis showed that, the level of pain reduction in the erythropoietin group was 52.5% higher than the rest of the treatment methods in first month after treatment. In comparison to dextrose group and in the 6th month after treatment, the rate of knee stiffness, functional limitations, and overall WOMAC score in patients treated with PRP were decreased 53.7%, 52.3% and 53.7%, respectively. In the third month after treatment, the knee range in patients treated with erythropoietin showed a 25.4% improvement, which was more effective than other procedures. According to study result, the effectiveness of intra-articular injection methods for knee osteoarthritis treatment and in order to reduce the pain level, respectively, were: erythropoietin, radiofrequency pulse, platelet-rich plasma, and dextrose. It should be noted that more research is needed to estimate the effectiveness of these methods in the long run.

Low back pain is one of the most common musculoskeletal disorders leading to disability in the world. Several studies have shown that long-term sitting is associated with low back pain and discomfort. The weakness of core stability is referred to as one of the factors associated with the low back pain. So the purpose of this study was the study of relationship between core stability and back discomfort and muscle activity during laptop work in the sitting position. Twenty young healthy males participated in this study. They performed laptop work (involving computer mouse work and typing task) in the sitting position. The electromyographic activity of back muscles and the posture of the lumbar spine were recorded in the first and last 2 min of each task. At the end of each task, the participants scored their back discomfort. Core stability was measured using McGill’s tests (including flexor, extensor, left side bridge and right side bridge tests). The Pearson and partial correlation test were used for analysis of correlation between variables. There was a negative significant correlation between core stability and activity level of the lumbar erector spinae (r= -57, p= 0.013) and left multifidus (r= -.50, p= 0.034), but correlation between discomfort and core stability was not found (r= 0.08, p= 0.748). Core stability appears to be an effective factor on the back muscles activation pattern during sitting. But confirmation of this issue requires further research. It is recommended to take in to account the core stability factor ,in the design of low back pain prevention interventions for people who committed sanitary works for long time.

Low back pain is the most common musculoskeletal disorder. There are several ways to treat back pain, but to achieve a short, easy and compress way is needed in today’s industrial societies. The aim of this study was to compare the effect of core stabilization training in water and on land on pain and dynamic postural stability in women with chronic non-specific low back pain. 36 women nonathletic with nonspecific chronic low back pain participated in this study. The subjects were randomly divided into three groups (control, n=12, experimental 1, n=12, experimental 2, n=12). there were no intervention for control group. The experimental group 1 performed core stability exercises in the water and the experimental group 2 performed core stability exercises on land carried out during 12 consecutive days. The Quebec test applied for assessing  pain and star test (SEBT) was used to measure dynamic balance before and after treatment,. For assessing Normal distribution of data from ShapiroWilk test for homogeneity of group’s variance Levene test, changes within the group of t-test and ANOVA test and Tukey post hoc test was used for between groups changes. The results showed that pain in both experimental group 1 (training in water) (P=0/001) and experimental 2 (training on land) (P=0/001) than the control group significantly decreased, as well as the pain in the experimental group 1was significantly decreased than experimental group 2 (P=0/001). The dynamic balance in both experimental groups 1 and 2 compared to the control group significantly increased; as well as dynamic balance in the experimental group2 compared to the experimental group1 was  significantly increased (P<0/05). In the short term, core stability exercises on land and water would reduce pain and improve balance in patients with chronic low back pain.