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Background & Aim: Vaccination is the most common painful procedure in childhood. This study aimed to compare the effect of Hugo point massage with and without ice on the injection-related pain of pentavalent vaccine in infants.
Methods & Materials: This study is a blind randomized clinical trial (IRCT2016052127982N1) conducted on 90 healthy, two-month old infants with normal weight, referred to Gonabad Fayazbakhsh health center to inject pentavalent vaccine in 2016. Infants were randomly assigned into three groups including 1) massage on Hugo’s point with ice 2) massage on Hugo’s point without ice and 3) control group. Data collection tool includes demographic information form and infant’s pain measurement tool. Data were analyzed using Chi-square test, Kruskal–Wallis test, analysis of variance and post-hoc Tukey HSD through the SPSS software version 16.
Results: There was no significant difference in pain intensity before vaccination between three groups. After vaccination, mean pain score for the first group was 7.70±1.26, for the second group was 8.03±1.06 and for the third group was 9.23±0.89. Also, crying duration in the first group was 35.03±23.12, in the second group was 40.39±21.62 and in the third group was 61.28±24.00. Both variables in the intervention groups were significantly lower compared to the control group (P<0.001) but there was no significant difference between the two intervention groups (P=0.586 and P=0.654).
Conclusion: Hugo’s point massage with and without ice can reduce the injection-related pain of pentavalent vaccine in infants and be used as a simple non-pharmaceutical method available to control vaccination pain.
 

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Background & Aim: Postoperative pain is one of the clinical challenges for nurses who care for patients. The objective of this review was to evaluate the effect of preoperative education on postoperative pain after elective surgery.
Methods & Materials: A literature search was done on PubMed, CINAHL, Cochrane Library, Web of Science, Scopus and EMBASE to find the articles published in English on clinical trials from January 2012 to June 2018.
Results: Out of 153 studies retrieved, 13 studies (2482 people) were reviewed. Generally, most studies indicated the effectiveness of preoperative education on postoperative pain relief (7 studies, n=1678). In other studies, there was no significant difference between education and the degree of pain reduction in the patient. Also, the results of some studies (n=204) showed that education with empathy could reduce anxiety in half of the cases.
Conclusion: Preoperative education as a complex intervention can reduce postoperative pain. Interactive education with empathy reduces patient’s anxiety and the need for postoperative analgesics. Therefore, training skilled nurses and the providers of such education is suggested for managing pain in patients.
 

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Background & Aim: Childhood vaccination as the most common iatrogenic pain is the main source of pain, anxiety and stress in children and parents, which is often done without pain management. Therefore, given the importance of pain control in children, and the recognition and application of pain control methods by the health team members, this study was conducted to evaluate the effect of ShotBlocker on vaccination pain in 6-month-old infants.
Methods & Materials: In this clinical trial study, 80 infants referred to Mehrshahr health center in Birjand in 2018-2019, were selected using the convenience sampling method based on the study criteria, and then randomly assigned to the control or experimental groups. In the experimental group, 20 seconds before the injection until the end of the injection, pressure was applied to the injection site with a ShotBlocker. The control group only received routine care. The pain status in the two groups was measured using the Pain Behavioral Response Scale (FLACC) 15 seconds after injection, and also the duration of crying from the time of vaccine injection to the end of crying was compared between the two groups. Data was analyzed using descriptive and inferential statistics including Mann-Whitney, t-test, and analysis of covariance at the significance level of less than 0.05.
Results: The study results revealed the mean pain intensity (4.32±0.99), duration of crying (14.4±3.92), and the time of onset of crying (4.05±0.933) were lower in the experimental group than those of in the control group (P<0.001).
Conclusion: Considering that ShotBlocker is effective in reducing pain intensity, the duration of crying and delay in onset of crying, it is recommended to use this simple, safe, and low-cost device to manage pain during vaccine injection.
Clinical trial registry: IRCT20191128045534N1
 

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Background & Aim: Pain during vascular access is an integral part of the life of hemodialysis patients. The aim of this study was to determine the effect of topical ginger on pain following needle insertion into the arteriovenous fistula in hemodialysis patients.
Methods & Materials: In this clinical trial, 100 hemodialysis patients were selected from two hospitals in Shahroud in 2019 and were randomly assigned to intervention or control groups. For the intervention group, ginger ointment was used 20 minutes before needle insertion into the arteriovenous fistula. The control group only received routine care. Patients' pain after needle insertion was assessed using the Numerical Pain Rating Scale. Data was analyzed using the SPSS software version 18 and Chi-square, Fisher, and independent t-tests.
Results: There was a statistically significant difference in the mean and standard deviation of pain scores between the control (8.46±1.26) and intervention (5.08±1.29) groups (P<0.001). While most people in the intervention group experienced moderate pain, most people in the control group had severe pain.
Conclusion: According to the results of the study, the use of topical ginger, which is cheap with almost no side effects, can reduce the severity of pain following needle insertion into the arteriovenous fistula in hemodialysis patients, and its use in hemodialysis wards is recommended.
Clinical trial registry: IRCT20190825044608N1
 

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Background & Aim: Self-care and self-management, as two effective strategies play an effective role in controlling pain and quality of life. Therefore, considering the characteristics and dimensions of these two concepts, this study aimed to compare the effect of self-care education and pain self-management on the nature of pain and quality of life in patients with sickle cell disease.
Methods & Materials: In this clinical trial study, 75 patients with sickle cell disease, referred to the thalassemia clinic of Baqaei hospital 2 in Ahvaz and Shahid Beheshti hospital in Abadan, were selected and randomly divided into three groups of 25 people (self-care, pain self-management and control groups). The two intervention groups (self-care and pain self-management) were divided into groups of five people, and received specific training during four sessions for three months. The nature of pain and quality of life of patients were assessed four times (before the intervention, one month, two months and three months after the intervention) using the McGill Pain Questionnaire and Quality of Life Questionnaire. The SPSS software version 22 was used to analyze the data.
Results: The results showed that pain self-management and self-care programs were effective in improving the quality of life and pain of patients with sickle cell. However, there was no statistically significant difference between the two intervention groups in the nature of pain and quality of life.
Conclusion: Self-care and pain self-management have similar effects on reducing patients’ pain and improving their quality of life.
Clinical trial registry: IRCT20160726029086N5
 

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Background & Aim: Although pain control in patients with burns has improved over recent years, the ineffectiveness of some treatments to reduce pain in this group of patients remains a challenging issue for health care professionals. This systematic review was conducted to investigate nursing interventions in the field of pain relief in burn patients.
Methods & Materials: In this systematic review and meta-analysis, relevant information was searched from databases PubMed, Science Direct, Scopus, Irandoc, SID, and Cochrane library with keywords nursing interventions, pain, burns and their equivalent Persian keywords in the period 2010-2020. To increase the validity and reliability of the study, three people evaluated the quality of the articles separately and Jedad criterion was used to evaluate the articles.
Results: After assessing 181 articles on the databases, 19 articles were systeatically reviewed. Nursing interventions to reduce pain in burn patients included using breathing techniques, new dressings, muscle relaxation, music therapy, transcutaneous electrical nerve stimulation (TENS), electrical brain stimulation, play therapy, aromatherapy, use of Zekr Allah, massage, guided imagery, distraction techniques, and eye movement desensitization. In eight meta-analyses, total mean differences of pain relief score were estimated 1.28 (0.95% CI: 0.78-1.78).
Conclusion: Most nursing interventions reduced pain in burn patients. Easier-to-use pain relief techniques such as muscle relaxation, guided imagery, and spiritual care are emphasized.

 

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Background & Aim: Chest pain is one of the main symptoms of acute coronary syndrome, and sleep disorders are among common problems in these patients. The aim of this study was to determine the effect of Curcuma Longa on chest pain and sleep quality in patients with acute coronary syndrome.
Methods & Materials: This triple-blind clinical trial was conducted on 270 patients in the Coronary Care Unit of Kowsar Hospital in Semnan, with random allocation to three groups (intervention, placebo and control) in 2020-2021. The intervention group received 500 mg of Curcuma Longa tablets and the placebo group received 500 mg of starch, Oisel and lactose tablets at 9 a.m. after breakfast once a day for 3 days. The control group received daily interventions. Chest pain was assessed using the pain assessment tool before the intervention and half an hour after the intervention for 3 consecutive days. Sleep quality was evaluated by the standardized sleep quality questionnaire of Saint Mary's Hospital in the morning of the first day before the intervention and in the morning of the second and third days after the intervention.
Results: There was no significant difference in the average reduction of chest pain intensity from the first to the third day between the groups (P>0.05). But there was a significant difference in the chest pain intensity within the intervention, placebo and control groups (P<0.001), and the average chest pain intensity on the second day compared to the first day of hospitalization decreased in three groups (P<0.001). However, the decrease in chest pain intensity on the third day compared to the second day of hospitalization was not significant in the three groups (P>0.05). The average score of sleep quality before the intervention in the intervention group was higher than that of in the placebo group (P=0.021), but on the second and third days of the intervention, it was lower in the intervention group compared to the placebo (P<0.001) and control groups (P<0.001).
Conclusion: The results showed that Curcuma Longa did not have a significant effect on chest pain in the patients with acute coronary syndrome, but it improved the quality of sleep. Therefore, Curcuma Longa can be used to improve the sleep quality of these patients.
Clinical trial registry: IRCT20110427006318N14

 

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Background & Aim: Reducing pain after surgery, especially cesarean section is one of the most important factors for maternal and infant health. Choosing the way of reducing pain with fewer complications has drawn the attention of researchers. The aim of this study was to compare the effect of Hugo point pressure and auricular seed acupressure on pain after cesarean section.
Methods & Materials: In this clinical trial, 168 pregnant women who were candidates for cesarean section, referred to the educational and medical centers of Rafsanjan University of Medical Sciences in 2020, were selected through purposive sampling and randomly divided into three groups: Hugo point pressure, auriculotherapy, and control. In the Hugo group, massage was applied on the li4 point (between the thumb and forefinger) for 10 minutes. 24 hours later, the intervention was repeated. Before and after the intervention, pain intensity was measured using the Visual Analogue Scale (VAS). In the auriculotherapy group, earrings were placed on the Shenmen point located in the earlobe. Pain was assessed by the VAS 20 minutes after the intervention and 24 hours later. No intervention was performed for the control group and only the researcher was present next to the studied subjects for 10 minutes. Data were analyzed by the SPSS software version 20 using paired t-test and one-way analysis of variance (ANOVA). P<0.05 was considered significant.
Results: The average pain score in the Hugo group was 6.70±1.55 before the intervention and 6.20±1.78 after the intervention (P=0.026). In the auriculotherapy group, the average pain score before the intervention was 5.99±1.75 and after the intervention was 4.66±2.01 (P<0.001). No significant difference was observed in the average score of pain intensity on the first day between the two groups, before the intervention (P=0.062). But the average score of pain intensity on the first day after the intervention was lower in the auriculotherapy group compared to the other two groups (P<0.001). On the second day, there was a significant difference in the average pain score between the three groups after the intervention (P=0.009).
Conclusion: The results of this study showed that both auriculotherapy and the Hugo method are effective for reducing pain after cesarean section; but the continuance of pain reduction after auriculotherapy was more than Hugo point pressure. These methods can be used along with other pharmaceutical methods to reduce pain after cesarean section.
Clinical trial registry: IRCT20131228015965N17

 

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Background & Aim: Considering the use of aromatherapy as a non-pharmacological method of pain control and a scarcity of studies in this area, the aim of the study was to compare the effect of breast milk odor and Rosa damascena aroma on pain and crying due to blood sampling in neonates.
Methods & Materials: In this cross over clinical trial study, 40 neonates hospitalized in the NICU of Ali Ibn Abitalib hospital in Rafsanjan were divided into two groups (breast milk odor and Rosa damascena aroma). In the first step, tree minutes before blood sampling until its completion, cotton soaked in 2 cc of breast milk was placed at a distance of three centimeters from the neonate’s nose. In the next step, cotton soaked with two drops of rose essential oil was used, similar to the method of breast milk. For the second sample, the order of interventions was changed. The pain was calculated with the NIPS instrument and crying with a stopwatch by a person who was blinded to the groups. The data were analyzed by STATA software version 14.
Results: The mean score of pain for two periods in two groups were 3.75±2.33 and 4.30±1.70 respectively, and there was no significant difference between the two groups (P=0.415). The mean score of crying for two periods in two groups were 16.98±16.21 and 15.03±9.99 respectively, and there was no significant difference between the two groups (P=0.650).
Conclusion: The breast milk odor and rose damascena aroma have a similar effect in reducing the pain of neonates. Thus, according to the conditions, each of these methods can be used.
Clinical trial registry: IRCT20150713023190N11

 

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Background & Aim: Pain and inflammation caused by needle insertion into the fistula is a common problem in hemodialysis patients. The aim of this study was to evaluate the effect of topical application of Rosemary essential oil on inflammation and pain severity caused by needle insertion into arteriovenous fistula in patients undergoing chronic hemodialysis.
Methods & Materials: In this clinical trial, 60 hemodialysis patients from the hemodialysis ward of Golestan hospital and Imam Khomeini hospital in Ahvaz were randomly assigned to two groups using block randomization. The intervention group received rosemary essential oil, while the control group received distilled water applied to the needle insertion site 5 minutes before each hemodialysis session. Pain severity was assessed using the VAS scale and inflammation severity was determined using the Phlebitis checklist at baseline and during six sessions. Data were analyzed using t-test, chi-square test and repeated measures analysis of variance (ANOVA) on SPSS software version 22.
Results: The results showed that the mean score for pain increased in the control group from 5.13±1.74  to 5.93±1.67, while it decreased in the intervention group from 5.83±1.53 to 3.77±1.43 (P=0.003). Additionally, the mean score for inflammation increased during the sessions in the control group, ranging from 1.27±1.20 to 2.07±1.08. However, in the intervention group, the mean score for inflammation decreased from 2.57±1.92 to 1.33±1.44. Nevertheless, this difference was found to be statistically insignificant (P=0.267).
Conclusion: The findings of the present study showed that the topical application of rosemary essential oil had a significant effect on reducing pain resulting from needling. However, its effect on reducing the severity of arteriovenous fistula inflammation in patients undergoing hemodialysis was not statistically significant. Based on these results, it is recommended to provide training to nursing staff and hemodialysis patients regarding the use of rosemary essential oil as a means to alleviate pain experienced during the procedure. Further research is required to investigate its potential for reducing the severity of fistula inflammation.
Clinical trial registry: IRCT2019102804526N1

 

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Background & Aim: Patients undergoing hemodialysis commonly experience discomfort due to the insertion of needles into their arteriovenous fistula. The aim of the study was to compare the effect of EMLA ointment and lidocaine spray, along with the use of rhythmic breathing on the intensity of pain caused by the insertion of needles in the arteriovenous fistula among hemodialysis patients.
Methods & Materials: This study was a randomized clinical trial conducted on a total of 80 patients who were referred to Imam Khomeini and Golestan hospitals in Ahvaz in 2022. The numerical pain measurement scale was used as the data collection tool. The participants were selected using the convenience sampling method and then randomly allocated into two groups. In the EMLA ointment group (n=39), a total of 2 grams of EMLA ointment was applied to the target area 60 minutes before the hemodialysis procedure. In the lidocaine spray group with rhythmic breathing (n=41), 2 puffs of lidocaine spray were administered along with rhythmic breathing 5 minutes prior to needle insertion. The pain intensity was then measured and recorded. The collected data was analyzed using descriptive and inferential statistics in SPSS version 20, with a significance level set at 0.05.
Results: The group receiving EMLA ointment and the group receiving lidocaine spray, with rhythmic breathing had mean pain scores of 1.95±1.09 and 2.12±1.10, respectively. Although the mean pain score in the EMLA ointment group was lower than that in the lidocaine spray group with rhythmic breathing, the difference was not statistically significant (P=0.479).
Conclusion: The findings of this study indicate that both EMLA ointment and lidocaine spray, along with the use of rhythmic breathing, have comparable efficacy in reducing pain among hemodialysis patients. Therefore, considering the patient's condition, the utilization of either of these methods is recommended.
Clinical trial registry: IRCT20220512054826N1

 

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Background & Aim: Postoperative pain, anxiety and sleep disturbances are common among patients undergoing orthopedic surgery, often leading to increased physical complications and substantial healthcare costs. Given the rising interest in non-pharmacological methods such as aromatherapy, this study aims to investigate the effectiveness of lavender inhalation aromatherapy in alleviating pain, anxiety and enhancing sleep quality in patients post-orthopedic surgery.
Methods & Materials: This randomized clinical trial was conducted in 2022 at a trauma center in Isfahan, involving 80 patients undergoing orthopedic surgery. Eligible patients were recruited through consecutive sampling and were randomly assigned to either the intervention group (n=40) or the control group (n=40). The intervention included inhalation of 100% pure lavender essential oil over a period of three days, while the control group received standard postoperative care. The study employed the Standard Spielberger anxiety questionnaires, the St. Marry’s Hospital Sleep Questionnaire (SMHSQ), and the Visual Analog Scale (VAS) for data collection. Data were analyzed using paired t-tests, independent t-tests, chi-square tests, and one-way repeated measures analysis of variance, utilizing SPSS software version 26.
Results: Post-intervention analysis revealed statistically significant differences in the average scores of anxiety and sleep quality between the intervention and control groups (P<0.001). Additionally, the average pain scores exhibited significant differences at all time points across both groups (P<0.001).
Conclusion: The findings show that lavender aromatherapy significantly reduces pain and anxiety while improving sleep quality in patients following orthopedic surgery. Given these positive effects, the integration of this cost-effective and easily accessible intervention is recommended as a complementary treatment, alongside conventional methods.
Clinical trial registry: IRCT20111002007692N3