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      Effect of Magnesium Sulfate Added to Tincture of Opium and Buprenorphine on Pain and Quality of Life in Women with Dysmenorrhea: A Prospective, Randomized, Double-blind, Placebo-controlled Trial

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          Adding magnesium sulfate (MgSO4) to opioid receptor agonists increases the opioid analgesic effects via blocking this receptor. The current study aimed to evaluate the effectiveness of adding MgSO4 to tincture of opium (TOP) and buprenorphine (BUP) on pain and quality of life (QOL).


          In prospective, randomized, double-blind, placebo-controlled clinical trial, one hundred and sixty-three women with secondary dysmenorrhea caused by endometriosis were selected using a respondent-driven sampling (RDS) and assigned into six groups using block randomization. Patients received 50 mg/kg MgSO4 in 100 ml saline by micro set in six monthly menstrual periods and completed the visual analogue scale (VAS) and QOL Questionnaire (QOLQ). Data were analyzed by repeated measures analysis of variance (ANOVA) and hierarchical regression.


          The primary outcomes showed that pain scores in magnesium (MAG) + opium tincture (OT) [F = 5.7(1,162), P = 0.004] and MAG+ BUP [F = 4.5(1,162), P = 0.006] groups showed a significant decrease compared with control group. Also, QOL scores in MAG + OT [F = 4.8(1,162), P = 0.005] and MAG + BUP [F = 5.9(1,162), P = 0.003] showed a significant increase. However, there was no significant difference between the two groups (P = 0.140) and the changes did not persist until follow-up (P = 0.810). Secondary outcomes indicated that the low scores of the two components of QOL including physical and psychological components were predictors of pain (P = 0.011, Beta > 3.09).


          Simultaneous use of MAG with opioids is associated with pain reduction and the improvement of QOL. However, this hypothesis requires careful handling in a randomized controlled trial.

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          Psychometric properties of the WHOQOL-BREF in an Iranian adult sample.

          To evaluate discriminant validity, reliability, internal consistency, and dimensional structure of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) in a heterogeneous Iranian population. A clustered randomized sample of 2,956 healthy with 2,936 unhealthy rural and urban inhabitants aged 30 and above from two dissimilar Iranian provinces during 2006 completed the Persian version of the WHOQOL-BREF. We performed descriptive and analytical analysis including t-student, correlation matrix, Cronbach's Alpha, and factor analysis with principal components method and Varimax rotation with SPSS.15. The mean age of the participants was 42.2 +/- 12.1 years and the mean years of education was 9.3 +/- 3.8. The Iranian version of the WHOQOL-BREF domain scores demonstrated good internal consistency, criterion validity, and discriminant validity. The physical health domain contributed most in overall quality of life, while the environment domain made the least contribution. Factor analysis provided evidence for construct validity for four-factor model of the instrument. The scores of all domains discriminated between healthy persons and the patients. The WHOQOL-BREF has adequate psychometric properties and is, therefore, an adequate measure for assessing quality of life at the domain level in an adult Iranian population.
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            Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain.

            The aim of this study was to find the cut-off points on the visual analogue scale (VAS) to distinguish among mild, moderate, and severe pain, in relation to the following: pain-related interference with functioning; verbal description of the VAS scores; and latent class analysis for patients with chronic musculoskeletal pain. A total of 456 patients were included. Pain was assessed using the VAS and verbal rating scale; functioning was assessed using the domains of the Short Form (36) Health Survey (SF-36). Eight cut-off point schemes were tested using multivariate analysis of variance (MANOVA), ordinal logistic regression, and latent class analysis. The study results showed that VAS scores ⩽ 3.4 corresponded to mild interference with functioning, whereas 3.5 to 6.4 implied moderate interference, and ⩾ 6.5 implied severe interference. VAS scores ⩽ 3.4 were best described for patients with chronic musculoskeletal pain as mild pain, 3.5 to 7.4 as moderate pain, and ⩾ 7.5 as severe pain. Latent class analysis found that a 3-class solution fitted best, resulting in the classes 0.1 to 3.8, 3.9 to 5.7, and 5.8 to 10 cm. Findings from our study agree with those of some other studies, although many other studies found different optimal cut-off point schemes. As there appear to be no universally accepted cut-off points, and in view of the low-to-moderate associations between VAS scores and functioning and between VAS and verbal rating scale scores, the correct classification of VAS scores as mild, moderate. or severe in clinical practice seems doubtful.
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              Quality of life associated to chronic pelvic pain is independent of endometriosis diagnosis-a cross-sectional survey

              Background Pain is strongly related to poor quality of life. We performed a cross-sectional study in a universitary hospital to investigate quality of life in women suffering from chronic pelvic pain (CPP) due to endometriosis and others conditions. Methods Fifty-seven patients aged between 25 and 48 years-old submitted to laparoscopy because of CPP were evaluated for quality of life and depressive symptoms. Quality of life was accessed by a quality of life instrument [World Health Organization Quality of Life Assessment-Bref (WHOQOL-bref)]. Causes of pelvic pain were determined and severity of CPP was measured with a visual analogue scale. According to the intensity of pelvic pain score, patients were classified in two groups (group Low CPP 25th percentile). Four dimensions on quality of life were measured (physical, psychological, social and environmental). We stratified the analysis of quality of life according CPP causes (presence or not of endometriosis in laparoscopy). Results Patients with higher pain scores presented lower quality of life status in psychological and environmental dimensions. We found a negative correlation between pain scores and psychological dimension of quality of life (r = -0.310, P = .02). Quality of life scores were similar between groups with and without endometriosis (physical 54.2 ± 12.8 and 51.1 ± 13.8, P = 0.504; psychological 56.2 ± 14.4 and 62.8 ± 12.4, P = 0.182; social 55.6 ± 18.2 and 62.1 ± 19.1, P = 0.325; environmental 59.2 ± 11.7 61.2 ± 10.8, P = 0.608; respectively) Conclusions Higher pain scores are correlated to lower quality of life; however the fact of having endometriosis in addition to CPP does not have an additional impact upon the quality of life.

                Author and article information

                Addict Health
                Addict Health
                Addiction & Health
                Kerman University of Medical Sciences
                October 2020
                : 12
                : 4
                : 259-268
                [1 ]Department of Psychology, School of Humanities, University of Science and Culture AND Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                [2 ]Department of Midwifery, School of Medicine, Qom Branch, Islamic Azad University, Qom, Iran
                [3 ]Bijan Center for Substance Abuse Treatment, Tehran, Iran
                [4 ]Department of Psychology, Kish International Branch, Islamic Azad University, Kish, Iran
                [5 ]Department of Health Psychology, North Tehran Branch, Islamic Azad University, Tehran, Iran
                [6 ]Department of Psychology, School of Psychology, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
                [7 ]Department of Food Science and Technology, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
                [8 ]Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                Author notes
                Correspondence to: Ladan Ajori; Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Email: ajori@ 123456sbmu.ac.ir
                © 2020 Kerman University of Medical Sciences

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

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