Evaluating the Relationship Between Myofascial Pain Syndrome (MPS) and Physical and Mental Health Status in Patients with Stroke

Background: Myofascial pain syndrome (MPS) is a non-inflammatory disorder with muscle stiffness and pain that occurs with the appearance of palpable and irritating nodules in the muscular system. Stroke is one of the most common neurological diseases that in many cases leads to disability and reduction of quality of life (QOL). Objectives: This study aimed to evaluate the relationship between MPS and physical and mental health (MH) status in patients with stroke. Methods: Using available sampling method, this case-control study included 260 patients with stroke. To collect data, demographic characteristics, Visual Analogue Scale (VAS), 36-item Short Form Survey (SF-36), and Depression, Anxiety and Stress Scale (DASS-21) were used. Data analysis was performed using SPSS 16. Mean and standard deviation were used for descriptive statistics and independent t-test, paired t-test, and analysis of variance (ANOVA) were used for inferential tests. Results: While the pain score was 6.35 (1.39), QOL score was 38.86 (11.69), and MH score was 16.26 (2.75) in the intervention group, these scores were 2.15 (0.96), 63.96 (17.52), and 9.02 (4.63), respectively, in the control group. The results showed no statistically significant relationship between MPS and QOL. But there was a statistically significant relationship between MPS and MH, so that the MH status of patients with MPS was lower than the MH status of other patients. Conclusions: Necessary interventions have been done to improve the health status of patients with MPS, which will lead to an increase in the health status of these patients.

A Simple and Cost-Effective Weight Drop Model to Induce Contusive Spinal Cord Injury: Functional and Histological Outcomes

Background: Animal spinal cord injury (SCI) models have provided a better perception of the mechanisms related to traumatic SCI and evaluation of the effectiveness of experimental therapeutic interventions. Objectives: The aim of this study is to develop a cost-effective modified Allen's device to induce contusive spinal cord injury. Methods: Adult male Wistar rats were subjected to contusive spinal cord injury using a customized weight drop model through 10-g weights delivered from a 25-mm height onto an exposed spinal cord. Locomotor and sensory function during 28 days were assessed. Moreover, histopathological changes were assessed at one week and 28 days post SCI. Results: All the SCI rats showed hind limb paralysis up to 48 h post SCI and neuropathic pain after injury. Histological changes similar to the previous reports for contusion model were observed. Conclusions: According to our findings, little variability was observed in the BBB score of individual rats at 28 days after injury. Our customized device to induce spinal cord injury is a simple and inexpensive alternative method to the highly sophisticated contusion device commonly used to induce SCI.

Association Between Pain with Disability in the Elderly with Dementia

Background: Elderly is one of the most important and critical periods of life, and paying attention to the issues and problems of this period is very important. Objectives: The present study was performed to investigate the relationship between pain and disability in the elderly with dementia in 2021. Methods: In the present cross-sectional descriptive study, 120 elderly people with dementia were included. The instruments used in the four sections were the demographic profile form, the P-APS pain observation tool, and Stanford Disability Questionnaire questions. the researcher identified the elderly with dementia by available sampling method and if the elderly with dementia were eligible and written informed consent was obtained from the elderly and their primary caregivers, the questionnaires were completed. Conditions of pain and disability were described by descriptive tests, and then the relationship between pain and the degree of disability in patients was analyzed by statistical analysis using SPSS16 software. Results: The results showed mean (SD) pain score was 14.45 (4.23), disability score was 12.75 (3.09), and fall score was 37 (30.8%). According to pain score status classification, 4 (3.3%) of the elderly had no pain, 8 (6.7%) had mild pain, 27 (22.5%) had moderate pain, and 81 (67.5%) had severe pain. There is a significant relationship between pain status and disability in the elderly with dementia. By increase in pain, the patients had more disability (P = 0.000, F = 79.971). Conclusions: As the pain increased, the disability of the elderly with dementia decreased. For this reason, preventive interventions are explained in this field.

Personalized Pain Medicine: Turning Theory into Policy

: On the one hand, patients, therapists, policy-makers, business people, and health organization managers need to approach medicine from different perspectives, each perspective being appropriate for each role. On the other hand, a lack of appreciation of the perspectives of the other vested interests diminishes their effectiveness in accomplishing what their respective roles demand. In this article, we explain the main difference between these perspectives along a spectrum ranging from highly individualist to highly collectivist views of medicine. We aim to show the gap between personal (individualistic) and social (collectivist) medicine models. We then present possible ways to close this gap. We argue that these differences need to be reconciled, at least to some extent, if medicine is to evolve along with other disciplines, such as engineering, to create and implement personalized solutions to patients' pains. We conclude by proposing a framework through which patients, practitioners, health organizations, business people, and policy-makers can develop enough of a mutual understanding of each other's perspectives, problems, and solution orientations to be able to work relatively harmoniously toward the common goal of creating bespoke solutions to individuals' pains.

Assessing the Antioxidant Activity of Dexmedetomidine by Measuring the Plasma Antioxidant Enzyme Activity of Catalase, Glutathione Peroxidase, and Superoxide Dismutase During Lumbar Spine Laminectomy

Background: Current knowledge on antioxidant properties of anesthetics is inconclusive. Nevertheless, experiments on different anesthesia-related drugs and techniques are growing. Objectives: The aim of this prospective blinded randomized study was to assess the effect of dexmedetomidine (Dex) infusion during anesthesia on oxidative stress resulting from lumbar laminectomy. Methods: The antioxidant activity of Dex compared to placebo (normal saline) was evaluated by measuring the antioxidant enzyme activity of catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPX). A total of 56 patients who underwent laminectomy surgery were allocated into two groups of intervention and control. Dex group received 0.6 µg.kg-1 dexmedetomidine infusion before induction of anesthesia over 15 minutes, followed by 0.4 µg.kg-1.hr-1 maintenance. Control group received the same volume and sequence of normal saline. Anesthesia protocol was similar in both groups. The antioxidant activity of the previously mentioned enzymes was measured at the beginning of the anesthesia (T1) and after surgery (T2). Propofol consumption, hemodynamic indices, shivering, bleeding volume, and pain numeric rating scale (NRS) were recorded. Results: Although the serum levels of CAT and GPX increased during the procedure, these changes were not significant (P-values 0.579 and 0.762, respectively). Also, the mean SOD level did not change over time in any of the groups, and it was not meaningfully different between the groups at any of the predetermined times (P-value 0.665). Conclusions: As expected, Dex decreased propofol consumption, mean heart rate, mean arterial pressure, and pain intensity allover the perioperative period. It seems that adding Dex to anesthesia regimen during laminectomy had no dominant antioxidant effects.

Long-Term Outcome Following Decompressive Craniectomy in Pediatric Penetrating Blast Brain Injury; a Prospective Study

Background: Brain penetrating blast injury is a leading cause of early death due to excessively elevated intracranial pressure (ICP), culminating in trans-tentorial herniation. The role of craniectomy to decrease ICP and secondary injuries has been controversial particularly in pediatric patients. Three cases of pediatric penetrating blast injuries undergoing decompressive craniectomy are reported in Methods: The current study was a prospective series, including fifteen cases of pediatric blast-related brain injury referred to the emergency ward during a period of two years. Three survived patients had a Glasgow Coma Scale (GCS) of four along with anisocoric pupillary light reflex (PLR). Decompressive craniectomy and ventriculostomy (EVD) were performed. The patients underwent ICP monitoring for two weeks. Results: Early postoperative GCS (5 days) was 7/15 in all three patients. Two weeks and one month’s GCS were 9 and 14, respectively. After three months, cranioplasty was performed. Long-term follow-up detected no major motor deficits after one year and was associated with excellent school performance. Neuroplasticity resulted in contralateral dominancy and handedness in one case. Conclusions: Survivors of pediatric blast brain injury had a favorable outcome after decompressive craniectomy in the current paper. However, there was a limited number of patients, and the results could not be generalized. Further research in this regard with larger sample size is recommended.

Effect of Ozonated Water on Oral Mucositis and Pain Induced by Head and Neck Radiotherapy: A Cross-sectional Study

Background: Oral mucositis and local pain are the negative effects of the treatment of head and neck cancer with radiotherapy. Objectives: The study aimed to investigate the effect of ozonated water on the severity of mucositis and pain in (1) patients who were treated with ozonated water and (2) patients who were not treated with ozonated water. Methods: We randomly divided 93 patients with head and neck malignancy (aged 18 to 80) into three groups. Ozone-treated group 1 rinsed their mouth with 15 mL of ozonated water with a concentration of 20 - 50 ppm from the first session of radiotherapy for one minute before and after each session. Ozone-treated group 2 rinsed their mouth with 15 mL of ozonated water with a concentration of 20 - 50 ppm for three minutes and then swallowed it before and after each session. Ozone-treated groups 1 and 2 and the non-ozone-treated group received standard treatment if mucositis symptoms appeared in each patient. The minimum number of radiotherapy sessions was 30, and the minimum planned dose for each patient was 50 Gray. Anamnesis and the following clinical parameters were taken: the degree of mucositis, the use of corticosteroids, radiotherapy method, radiation dose, and Pain Visual Analog Scale. Multi-level and subgroup analyses were performed on the ozone-treated and non-ozone-treated levels. Results: The mean degrees of oral mucositis and pain were lower in the ozone-treated group 2 than in the ozone-treated group 1 and non-ozone-treated group (P < 0.05). The non-ozone-treated group had the highest degrees of oral mucositis and pain severity (P < 0.05). The Kruskal-Wallis H test showed that there was a statistically significant difference in the Visual Analog Scale of sessions 5, 10, 15, 20, 25, and 30 between different groups. However, there was no statistically significant difference in the Visual Analog Scale of session 1 (χ2 (2) = 1.022, P = 0.6). This study revealed that ozonated water can be used for preemptive pain control and mucositis. This finding aligned with previous studies. Also, former research proved the safety and efficacy of ozonated water in dentistry and medical uses. Conclusions: The use of ozonated water in patients with head and neck malignancy can reduce the pain severity and oral mucositis induced by radiotherapy. It seems that ozonated water can be used as a preemptive agent in patients who receive head and neck radiotherapy.

Demographical, Anatomical, Disease-Related, and Occupational Risk Factors for Carpal Tunnel Syndrome

Background: Carpal tunnel syndrome (CTS) is the most common focal mononeuropathy. It causes characteristic symptoms, including numbness and paresthesia in hand due to median nerve compression at the wrist. Objectives: We aimed to investigate CTS prevalence and personal, psychosocial, biomedical, and occupational factors related to it comprehensively, according to scattered publications, without the simultaneous evaluation of all CTS risk factors. Methods: A total of 345 patients referred to a hand clinic with a complaint of paresthesia in upper extremities and suspected CTS. The patients underwent neurological assessment and electrodiagnostic (EDX) tests to confirm the diagnosis. The demographic information, past medical history, past trauma history, and occupational history of all the patients were recorded and finally analyzed with SPSS software. Results: Of the patients, 213 (67.1%) met the criteria for CTS, of whom 160 (75%) were female. Females were significantly more affected by CTS than males (P < 0.05). The mean age was higher in the CTS patients (53.80 ± 11.57 years) than in non-patients (42.39 ± 12.31 years, P < 0.001). No statistical relevance was found between CTS prevalence with occupational history, underlying medical conditions, positive Tinel’s and Phalen's tests, and muscle atrophy. Conclusions: We recognized age and gender as main determinants in developing CTS. We also found that older age was related to higher CTS intensity.

Challenges of Patients with Spinal Cord Injury During the COVID-19 Pandemic: A Qualitative Study

Background: Spinal cord injury (SCI) is a chronic condition leading to physical and psychological problems along with numerous economic burdens for patients. In late 2019, an unknown disease called COVID-19 broke out, which quickly spread throughout the world. Objectives: The aim of the present study was to determine the challenges of SCI patients during the COVID-19 pandemic. Methods: This was a qualitative study performed among SCI patients after obtaining the code of ethics from the Research Ethics Committee of Ilam University of Medical Sciences in 2021. Data were collected using semi-structured, face-to-face individual interviews, in accordance with health protocols, in a safe environment without stress until reaching data saturation. Data were saturated after interviewing nine patients; to ensure data saturation, two additional interviews were conducted. Each interview lasted between 30 and 45 minutes, depending on the condition of each patient. The written files of the interviews were analyzed using MAXQDA software. Results: The mean age of the participants was 54 years, and 68% of the participants were male. After analyzing the data obtained from in-person interviews, three main themes, including expectations (need for financial support, need for social support, and need for physical support), concerns (fear of loneliness and fear of death), and health needs (health literacy, access to services and how to transmit the disease), were extracted. Conclusions: Considering the challenges in the three areas of expectations, concerns, and health care, it is necessary to take some measures to reduce these challenges.