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The purpose of this research was to determine the effectiveness of group counseling with an existential approach on pain control, emotional regulation and social adaptation of patients with malignant gastrointestinal cancers. The design of the research was semi-experimental and pre-test, post-test and two-month follow-up with a control group. The research population included all patients with malignant gastrointestinal cancer referred to Omid Hospital and Reza Specialized Oncology Center in Mashhad in the summer of 2021 whom 30 patients were randomly selected in two experimental groups (15 people) and control. (15 people) were placed. McGill's pain research tool was Gross Emotional Regulation and Social Adaptation (SAS), which was implemented on subjects in order to collect information in three stages: pre-test, post-test and follow-up. In order to analyze the data, the variance analysis test with repeated measurements was used. The findings indicated that group counseling with an existential approach has an effect on pain control, emotional regulation and social adaptation of patients with gastrointestinal malignant cancers (p>0.05); It should be mentioned, the durability of the treatment effect was maintained after three months (p>0.05). Based on the findings of this research, it can be concluded that group counseling with an existential approach can be used in the field of pain control, emotional regulation and social adaptation of patients with malignant gastrointestinal cancers

IntroductionAlthough laparoscopic surgery causes less postoperative pain than open surgery, however, the pain at the site of the laparoscopic port incision and in the shoulder and upper abdomen are the main complaints. Moreover, since postoperative nausea and vomiting (PONV) is the other complaints of these patients, it is important to adopt measures to address this issue (1-5).Today, acetaminophen is one of the most widely used analgesics due to its efficacy, safety, low side effects, and rare drug interactions (5, 6). Acetaminophen has different mechanism of actions that some of them have not been identified yet. It controls pain by preventing the production of prostaglandin E2, indirectly activating the cannabinoid receptor type 1, inhibiting the nitric oxide system by involving N-methyl-D-aspartate and substance P, and directly by stimulating descending serotonergic pathways that hinder pain signals transmitted by the spinal cord. Serotonin 5-Hydroxytryptamine (5-HT3) receptor antagonists, such as ondansetron, are at the front line of PONV treatment (7, 8). Furthermore, use of intravenous acetaminophen can also reduce PONV and the rate of antiemetic consumption (9-12). PONV is a common complication with a prevalence rate of 20-30% (3, 10). Ondansetron is the selective 5-HT3 antagonist which is effective in the prevention of PONV particularly if administered prior to the onset (3). In laparoscopic cholecystectomy, ondansetron administration can reduce the incidence of PONV in the first 4 h after the surgery (1). Ondansetron, in addition to triggering zone chemoreceptor in the medulla oblongata, affects the 5-HT3 receptor in the spinal cord on the pathway that modulates pain transmission signals. Some studies proposed that since ondansetron has antagonistic effects on 5ht3 receptors, it can reduce analgesic effects of acetaminophen. Therefore, ondansetron may be present at the 5-HT3 receptor of acetaminophen antagonist since the two medications have opposite effects on the 5-HT3 pathway (7).However, other studies have not concluded that co-administration of 5ht3 antagonists such as ondansetron and tropisetron could reduce the analgesic effects of acetaminophen. Moreover, review of literature showed one study which claimed direct analgesic effects for 5-HT3 antagonists (7, 12-17).Metoclopramide is another medication used to control PONV, and some studies reported the analgesic effects of this medication (18-22). Khazaei et al. and Karacabey et al. examined the effect of metoclopramide on migraine headaches and confirmed the results of previous studies regarding the positive effect of metoclopramide in reducing such headaches (19, 20). Ceyhan and colleagues conducted an experimental study on male rats and reported that metoclopramide could reduce incisional pain (22).Contrary to the laboratory results, the findings of some clinical studies have indicated that ondansetron did not reduce or even increased the analgesic effect of acetaminophen; however, the results of some studies have reported the blockage or reduction of this effect. According to our researches, there was no study on analgesic effect of co-administration of metoclopramide and acetaminophen and comparing its analgesic effect with ondansetron; therefore, this study was performed aimed to evaluate the effect of adding ondansetron and metoclopramide to intravenous acetaminophen on pain control and postoperative nausea and vomiting of patients undergoing laparoscopic cholecystectomy. MethodsThis double-blind clinical trial study with a parallel design was conducted in 2019 on patients undergoing laparoscopic cholecystectomy in the central operating room of Ghaem Hospital in Mashhad, Iran. According to the study by Koyunco et al. (7), the sample size was estimated to be 25 patients in each group by confidence level of 95% and power of 80%; finally, considering the possibility of 10% drop, 28 patients were considered in each group The study population consisted of all patients undergoing laparoscopic cholecystectomy. Participants were selected by Convenience Sampling method and entered the study after obtaining the written informed consent. The subjects were randomly allocated to three groups using the selection of sealed envelopes by the researcher. The first group (group A) received 1 g of intravenous acetaminophen by infusion 30 minutes before the end of surgery plus 4mg of ondansetron at the end of procedure. The second group (group B) was administered 1 g of intravenous acetaminophen by infusion 30 minutes before the end of surgery plus 8 mg of ondansetron at the end of procedure. The third group (group C) took 1 g of intravenous acetaminophen by infusion 30 minutes before the end of surgery plus 10 mg of metoclopramide at the end of procedure. Postoperative pain was measured as a primary outcome using the Numeric Rating Scale (NRS) after transferring the patient to the recovery room when patients' consciousness returned, before leaving the recovery room and 6 h after the operation in the ward. According to this scale, patients were asked to score their pain from a score of 0= no pain to 10= the most pain they have ever experienced. The validity and reliability of this scale have been investigated in various studies (23,24). Analgesic drug (other than acetaminophen) was injected for patients who had NRS score of ˃ 4.Demographic data, including age, weight, gender, and the duration of surgery were also recorded. The severity of nausea and vomiting before leaving the recovery was assessed by the PONV scale, which was developed by Wengritzky et al., who also evaluated its validity and reliability. In this 4-item scale, the highest score of items one or two is multiplied by the scores of items three and four to render the PONV score in the first 6 h after surgery (25).The inclusion criteria were: class I and II ASA age of 18-64 years, ability to communicate, no drug addiction, no analgesic administration in the last 24 h, no ondansetron or metoclopramide intake in the last 24 h, no chronic pain, and no history of sensitivity to acetaminophen, ondansetron, and metoclopramide.The exclusion criteria were: unusual and severe side effects of anesthesia, such as a severe drop (more than 50% of the baseline) in systolic blood pressure and heart rate that doesn’t respond to initial treatment, surgical complications which turned the procedure into an open surgery or despite managing the surgery with the closed approach, the operation lasted for more than 50% of the average of other operations, and the incidence of PONV, which required treatment with any of the medications in the family of 5-hydroxytryptamine inhibitors.All participants were completely monitored. General anesthesia was induced with propofol 2.5 mg/kg, atracurium 0.5 mg/kg, fentanyl 2 mcg/kg, and midazolam 20 mcg/kg. Maintenance of anesthesia was continued with propofol at a dose of 100-200 mcg/kg/min and remifentanil at a dose of 0.2-0.3 mcg/kg/min. The laparoscopic procedure and employed equipment were identical for all patients.In addition to the patients and the statistical analyzer, the person completing the NRS and PONV scales was also blinded to the groups. Kolmogorov-Smirnov test was applied to assess the normal distribution of quantitative variables. Qualitative variables were expressed in the form of frequency and percentage, quantitative variables in the form of mean (standard deviation), or with median (1st and 3rd quarters) in the case of a non-normal distribution. Chi-square and Fisher's exact test were used to evaluate the equality of proportions of qualitative variables among the three groups. Analysis of variance was used to compare the mean of quantitative normal variables in the three groups. The marginal model of generalized estimate equations (GEE) was used for intragroup and intergroup comparisons. Bonferroni's post hoc test was used for pairwise comparisons. Data was analyzed using SPSS software (version 25.0). P< 0.05 was considered statistically significant. Ethical considerationsThis research was approved by the Ethics Committee of Mashhad University of Medical Sciences, Mashhad, Iran (Ir.mums.medical.rec.1397.593) and registered in the Iranian Registry of Clinical Trials (IRCT20160516027925N4). Informed consent was obtained from the patients before entering the study. All the conditions, the possibility of study withdrawal and how to access the results were explained to the participants orally and in written form. The data of this study can be obtained by sending an email request to the corresponding author while maintaining the confidentiality of the patients' information. ResultsA total of 84 individuals participated in this study, among them 1 case in the third group was excluded due to surgical complications leading to open surgery (Figure 1). In the acetaminophen + ondansetron 4mg (group A), acetaminophen + ondansetron 8mg (group B), and acetaminophen + metoclopramide (group C), 77.8%, 75.0%, and 74.1% of the patients were female, respectively. According to the Analysis of variance, Chi-square and Kruskal Wallis tests, all three groups were homogeneous in terms of gender (P=0.947), age (P>0.802), weight (P=0.724), and the duration of surgery (P>0.99). The summary of demographic information and the duration of surgery were presented in Table 1.The patients' PONV mean scores in the acetaminophen + ondansetron 4mg (group A), acetaminophen + ondansetron 8mg (group B), and acetaminophen + metoclopramide (group C) groups were AllocationEnrollment Assessed for eligibility (n=84)Excluded (n=0)¨ Not meeting inclusion criteria (n=0)¨ Declined to participate (n=0)¨ Other reasons (n=0)Randomized (n=84)Analysed (n=27) ¨ Excluded from analysis (n=0)Analysed (n=28) ¨ Excluded from analysis (n=0)Analysed (n=28) ¨ Excluded from analysis (n=0)AnalysisAnalysisAnalysisLost to follow-up (n= 0)Discontinued intervention (n=0) Lost to follow-up (n= 0)Discontinued intervention (n=0)Lost to follow-up (n=0)Discontinued intervention (due to surgical complications leading to open surgery) (n=1) Follow-UpFollow-UpFollow-Up¨ Group C: Received Acetaminophen + Metoclopramide (n=28)¨ Did not receive allocated intervention (n=0)¨ Group B: Received Acetaminophen + Ondansetron 8mg (n=28)¨ Did not receive allocated intervention (n=0)¨ Group A: Received Acetaminophen + Ondansetron 4mg (n=28)¨ Did not receive allocated intervention (n=0) Figure 1. CONSORT flow diagram of the study calculated at 160.61±241.31, 127.39±206.19, and 137.15±214.23, respectively. Kruskal-Wallis test showed no significant difference among the three groups in terms of PONV mean scores (P=0.812). A summary of the main findings was provided in Table 2.The mean of the interval between the end of surgery and the first analgesia injection were obtained at 2.14±1.18, 1.79±0.74, and 3.76±1.22 h in the A, B and C groups, respectively. Kruskal-Wallis test showed significant difference among the three groups in this regard (P0.999); however, significant differences were observed between the A and B groups (P0.999***a was expressed in frequency (percentage), b mean±standard deviation, c mean±standard deviation with median (1st quarters, 3rd quarters) in the case of a non-normal distribution.* Chi-square ** ANOVA *** Kruskal-Wallis The mean of pain score at the time of the first analgesia injection were estimated at 6.54±1.07, 6.79±0.83, and 7.04±8.60 in the A, B and C groups, respectively. Kruskal-Wallis test showed no significant difference among the three groups in this regard (P0.999B vs C P0.999After surgery and before leaving recovery (2)4.64±2.084 (3 , 6.75)Six hours after surgery (3)4.43±1.836 (3 , 6) acetaminophen + ondansetron 8mg (B)After surgery in recovery (1)4.57±2.063 (3 , 7)1 vs 2p>0.9991 vs 3p= 0.4412 vs 3p>0.999After surgery and before leaving recovery (2)4.89±2.024 (3 , 7)Six hours after surgery (3)5.11±1.576 (3 , 6) acetaminophen + metoclopramide (C)After surgery in recovery (1)1.59±1.672 (0 , 2)1 vs 2p= 0.2751 vs 3p4, and the same conditions of surgical procedure and anesthesia drugs during surgery. AcknowledgmentsThis study was derived from the dissertation of Nadia Azari to receive a professional doctorate (No. 961680). The authors would like to thank the participants and all personnel of Ghaem Hospital, affiliated to the Mashhad University of Medical Science, for contribution to the present study, as well as the staff of Mashhad University of Medical Sciences for financial support. The research was approved by the Ethics Committee of the Medical School with code of IR.MUMS.fm.REC.1396.678 and IRCT code of IRCT20160516027925N3.Conflicts of interestThe authors declared no conflict of interest.

Background and Aim: Treatment of acute postoperative pain is one of the most important measures to improve recovery. Different methods of local and regional anesthesia, and also numerous intravenous drugs have been used. In this study, the analgesic effect ketorolac, paracetamol and pethidine in the postoperative pain control of outpatient transurethral lithotripsy was evaluated. Materials and Methods: This clinical trial was performed on 96 patients who were candidates for outpatient transurethral lithotripsy in Mashhad Imam Reza Hospital. In randomized double blinded study, at the end of the operation, 30 mg of intravenous ketorolac to the first group, 1 gram paracetamol in half an hour to the second group and 50 mg of pethidine to the third group were injected. Pain was assessed every 10 minutes to half an hour and then, every half an hour to 4 hours by numerical rating scale (NRS). Finally, the data were analyzed by SPSS v16 software. The relationship between quantitative variables was analyzed by analysis of variance and the qualitative variables was assessed by Chi-square test and P

Background and Aim: Treatment of acute postoperative pain is one of the most important measures to improve recovery. Different methods of local and regional anesthesia, and also numerous intravenous drugs have been used. In this study, the analgesic effect ketorolac, paracetamol and pethidine in the postoperative pain control of outpatient transurethral lithotripsy was evaluated. Materials and Methods: This clinical trial was performed on 96 patients who were candidates for outpatient transurethral lithotripsy in Mashhad Imam Reza Hospital. In randomized double blinded study, at the end of the operation, 30 mg of intravenous ketorolac to the first group, 1 gram paracetamol in half an hour to the second group and 50 mg of pethidine to the third group were injected. Pain was assessed every 10 minutes to half an hour and then, every half an hour to 4 hours by numerical rating scale )NRS(. Finally, the data were analyzed by SPSS v16 software. The relationship between quantitative variables was analyzed by analysis of variance and the qualitative variables was assessed by Chi-square test and P<0.05 was considered significant. Results: There was no significant difference between three groups in demographic information. The pain intensity in the first 10 minutes after surgery was the same between the groups (P=0.372), but the pain intensity at 20, 30 and 60 minutes after surgery was significantly different in the three groups )P.values 0.005, 0.006, and 0.001 respectively(, and was lower in the pethidine group. In other hours after surgery, no significant difference in pain control was observed between the three groups. The need for additional analgesia was higher in the paracetamol group than in the other two groups (P=0.025) in the first hour. Hemodynamic changes and surgical complications such as nausea and vomiting were the same in both groups. Conclusion: The present study showed that pethidine causes better pain relief than ketorolac and paracetamol in the first hour after surgery, but after 60 minutes there is no significant difference between these three groups. [ABSTRACT FROM AUTHOR]

Background and purpose: Leukemia is a group of cancers caused by accumulation of malignant white blood cells in the blood or bone marrow. The aim of this study was to investigate the efficiency of hypnotherapy on pain relief, death anxiety, resilience, and healing of cancer cells in patients with acute myeloid leukemia treated with chemotherapy. Materials and methods: A quasi-experimental study was carried out in which the research population were 86 patients of whom 26 (aged 30-50 years old) were selected via convenience sampling. They were randomly assigned into either experimental group or control group. Flow cytometry tests were done to confirm acute myeloid leukemia. The McGill Pain Management, Connor-Davidson Resilience scale, and the Collett-Lester Fear of Death Scale were administered to collect the data. Hypnosis therapy (six sessions) was done in experimental group. Data were analyzed applying analysis of covariance in SPSS V22. Results: Hypnosis therapy was found to have significant effects on mental dimensions in experimental group compared to the control group (P= 0.039). Follow-up investigations showed more changes in death anxiety compared with other two dimensions in experimental group (6.67). Laboratory results indicated the onset of inflammatory reaction in experimental group. Conclusion: Hypnotherapy is a powerful method in caring for cancer treatment.

Introduction: It is very painful and anxious for children to undergo venous and injection procedures. Exposure of children to severe pain and anxiety can cause mental health problems. There are several ways to reduce pain during injection. In this study, we examine two pharmacological and nonpharmacological methods of reducing the severity of pain in children during injection. Materials and Methods: In this systematic review study, all Iranian articles published in Persian were searched in databases of Sid, Medlib, Google scholar, Magiran and Iran Medex with Persian keywords of pain control, vein taking, injection and thought diversion in children. Of the many obtained articles, 20 articles were reviewed. Results: In the evaluated studies, they had compared the pharmacological methods such as use of spelling cream and non-pharmacological methods such as thought deviation (music, bubble making, touch, acupressure, musical ball, injection on doll, massage, relaxation methods, respiratory exercises). Among them, the method of thought deviation was the most common method used for pain reduction during injection. Most of the reviewed studies reported that the use of non-pharmacological methods to reduce the feeling of pain in children has positive results. Conclusion: The results of studies showed that non-pharmacological methods have a greater effect on controlling children's pain during injection. Also, since non-pharmacological methods (thought deviation) are much less expensive and cost-effective than pharmaceutical methods (spelling cream), so different methods of thought deviation can be a good alternative to nonpharmaceutical methods such as spelling cream. [ABSTRACT FROM AUTHOR]

Introduction: It is very painful and anxious for children to undergo venous and injection procedures. Exposure of children to severe pain and anxiety can cause mental health problems. There are several ways to reduce pain during injection. In this study, we examine two pharmacological and nonpharmacological methods of reducing the severity of pain in children during injection. Materials and Methods: In this systematic review study, all Iranian articles published in Persian were searched in databases of Sid, Medlib, Google scholar, Magiran and Iran Medex with Persian keywords of pain control, vein taking, injection and thought diversion in children. Of the many obtained articles, 20 articles were reviewed. Results: In the evaluated studies, they had compared the pharmacological methods such as use of spelling cream and non-pharmacological methods such as thought deviation (music, bubble making, touch, acupressure, musical ball, injection on doll, massage, relaxation methods, respiratory exercises). Among them, the method of thought deviation was the most common method used for pain reduction during injection. Most of the reviewed studies reported that the use of non-pharmacological methods to reduce the feeling of pain in children has positive results. Conclusion: The results of studies showed that non-pharmacological methods have a greater effect on controlling children's pain during injection. Also, since non-pharmacological methods (thought deviation) are much less expensive and cost-effective than pharmaceutical methods (spelling cream), so different methods of thought deviation can be a good alternative to nonpharmaceutical methods such as spelling cream. [ABSTRACT FROM AUTHOR]

Background and purpose: Leukemia is a group of cancers caused by accumulation of malignant white blood cells in the blood or bone marrow. The aim of this study was to investigate the efficiency of hypnotherapy on pain relief, death anxiety, resilience, and healing of cancer cells in patients with acute myeloid leukemia treated with chemotherapy. Materials and methods: A quasi-experimental study was carried out in which the research population were 86 patients of whom 26 (aged 30-50 years old) were selected via convenience sampling. They were randomly assigned into either experimental group or control group. Flow cytometry tests were done to confirm acute myeloid leukemia. The McGill Pain Management, Connor-Davidson Resilience scale, and the Collett-Lester Fear of Death Scale were administered to collect the data. Hypnosis therapy (six sessions) was done in experimental group. Data were analyzed applying analysis of covariance in SPSS V22. Results: Hypnosis therapy was found to have significant effects on mental dimensions in experimental group compared to the control group (P= 0.039). Follow-up investigations showed more changes in death anxiety compared with other two dimensions in experimental group (6.67). Laboratory results indicated the onset of inflammatory reaction in experimental group. Conclusion: Hypnotherapy is a powerful method in caring for cancer treatment. [ABSTRACT FROM AUTHOR]

Pain is the most common type of stress encountered by humans, especially children. Medications and non-pharmaceutical techniques are used to control pain. The present study aims at examining two non- pharmaceutical methods of pain control, namely relaxation and attention deviation in children admitted to state hospitals. To this end, 51 hospitalized children are selected via convenience sampling method, and once homogenized; they are placed in three equal groups: relaxation, attention deviation and control group. The results of analysis of single- variable covariance show that perception of pain decreases in the two experimental groups compared to the control group, and that relaxation is more effective than the attention deviation method. It can be concluded that two methods of attention deviation and relaxation can be used as non- pharmacological methods along with other methods of pain control in children and cause them to get along with their pain more easily.

Introduction: Pain control is of utmost importance in all dentistry fields. Anesthetic injection is perhaps the most difficult part of treatment in children. The most common anesthesia technique in the mandible is the inferior alveolar nerve block. As the block injection has a lasting anesthetic effect in children and also might cause traumatic injuries to soft tissues a different injection technique is needed. This study compared infiltration and block techniques for pain control during pulpotomy in the primary first mandibular molars.Materials and Methods: In this clinical study forty 5-8 year-old children were chosen. The subjects needed bilateral pulpotomy of primary mandibular first molars. This study was conducted based on a cross-over design. The patients were randomly divided into two groups. The patients in group A received an infiltration injection on the right side and a block injection on the left during the first and second sessions, respectively. The patients in group B received a block injection on the right side and an infiltration injection on the left during the first and second sessions, respectively. The patient pain was recorded at the moment of injection and on pulp exposure based on SEM (Sound Eye Molar) scale. Data was analyzed by Mann-Whitney U and Wilcoxon signed-rank tests. Statistical significance was defined at α = 0.05.Results: The results showed that at the moment of injection the SEM in the infiltration technique was significantly lower than that in the block technique, which demonstrates that the child can better tolerate the pain in the infiltration injection (p value < 0.001). However, the two techniques did not show significant differences in pulpal anesthesia based on the SEM scale.Conclusion: It seems the infiltration technique is superior to the block technique in controlling pain during pulpotomy in the mandibular primary first molars in 5-8 year-old children. Key words: Inferior alveolar nerve block, Infiltration anesthesia, Pulpotomy, SEM Scale, Pain control.

Background & Aims: In NICU some painful procedures can be happened for neonates. Neonates pain is a stressful experience to their parents. This research was done to determine the effect of mother presence on their views to pain control in neonates in Intensive care units. Materials & Methods: This research was a quasi experimental study. The sample based on pilot study on 20 mother was 150. The instrument for data gathering was a questionnaire including demographic variables and 24 MCQ questions that measured mothers' views about neonates pain control before and after their presence in NICU. To analyze the data, SPSS 18 was used and significant difference was lower than 0. 05. Result: There was significant difference in views before and after intervention (p<0. 001). Results showed a relation between mothers age (21-30) and their views (p<0. 05). Linear regression results showed visit times had affect on views (p<0. 002). Conclusion: Mothers want to stay near their children if painful procedures decrease. Therefore, we should try to limit invasive techniques and because of their important role in care, we can encourage them to cooperate doing procedures. [ABSTRACT FROM AUTHOR]