Tehran University Medical Journal

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Background: There are multiple diagnostic methods for evaluation of patients with low back pain with a radicular pattern, each one has it's own accuracy and diagnostic ability and so comparing them with each other would help the clinicians to find the best diagnostic method. The main objective of our study was to compare the diagnostic accommodation of electromyography (EMG) and Magnetic Resonance Imaging (MRI) findings in patients with low back pain and radiculopathy.

Methods: In this descriptive cross-sectional study, 101 patients with low back pain and radiculopathy attending to Sina Hospital in Tehran, Iran from 2007 to 2009 that had indication for both EMG and MRI were evaluated for their demographic characteristics and disease-related factors.

Results: Totally, 90 out of 101 patients (89%) had abnormal EMG findings and 94 out of 101 subjects (93%) had abnormal MRI results. The concordance rate was 88% (89 patients) with no significant difference (p> 0.05). The sensitivity and specificity of MRI were 95.6% and 27.3%, respectively, and the sensitivity and specificity of EMG were 91.5% and 60%, respectively.

Conclusion: According to the results of this study and in comparison with other studies it may be concluded that MRI and EMG are both accurate and use of them in a concomitant manner would result in increased diagnostic ability in patients with low back pain and radiculopathy.

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Background: The irritable bowel syndrome (IBS) is one of the most common chronic medical conditions. Various mechanisms, including altered gut flora and/or small bowel bacterial overgrowth, have been suggested to play a role in the development of gas-related symptoms aim of study. The clinical evidence of small intestinal bacterial overgrowth as an important etiology of irritable bowel syndrome continues to accumulate. Clinical symptoms of bacterial overgrowth and irritable bowel syndrome are similar however, a definitive cause-and-effect relationship remains unproven. It is unclear whether motility dysfunction causes bacterial overgrowth or gas products of
enteric bacteria affect intestinal motility in irritable bowel syndrome.

Methods: In a randomized double-blind placebo-controlled trial consisting of treatment with bismuth subcitrate. Primary efficacy variable was subjective symptoms frequency of abdominal pain, Number of bowel movement & Bloating/distension.

Results: 119 patients were enrolled (59 bismuth subcitrate and 60 placebo recipients). At the end of phase 2, all symptom scores dropped significantly both in bismuth subcitrate and placebo group (p<0.001). There was not a significant difference in symptom relief with bismuth subcitrate versus placebo administration.

Conclusions: There was not a significant difference in symptom relief with bismuth subcitrate versus placebo in IBS patients. Whether antibiotics can improve quality of life in patients with irritable bowel syndrome warrants further research.
Interventions: Participants were randomly assigned to receive 120mg bismuth subcitrate four times daily for 14 days (n=59) or placebo (n=60).

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Background: Infection with Taenia saginata or taeniasis is an uncommon parasitic infection in Iran with a prevalence rate of 2-3% and it is more seen in the northern parts of the country. Epigastric pain, nervousness, dizziness, nausea and loss of appetite may be the only presenting symptoms but secondary appendicitis, acute intestinal obstruction and necrosis of the pancreas are its serious and rare complications. Case presentation: A 62-year old woman was admitted to Imam Khomeini Hospital with signs of acute abdomen. She had a past history of infection with hydatid cyst and its subsequent surgery, eight years ago. At the time of admission, she suffered from persistent abdominal pain and loss of appetite for two years. Despite having the epidemiological evidence of working along the banks of rivers contaminated with human sewage and working on farms fertilized with human waste and presence of signs hinting at the disease, parasitic infection had not been considered in its diagnosis. Conclusion: Although signs and symptoms of taeniasis are non-specific but a complete history, physical examination and detailed patient notes, especially by considering epidemiological factors, are very important to the early diagnosis of taeniasis

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Background: Non-steroidal anti-inflammatory drugs (NSADs) and opioids are frequently administered to relieve postoperative pain. Uncontrolled postoperative pain may produce a range of detrimental acute and chronic health consequences and increase mortality and morbidity. Practically, the analgesic efficacy of opioids is typically limited by the development of tolerance to them or by opioid-related side- effects such as nausea, vomiting, sedation or respiratory depression. This study aims to assess the effects of suppository diclofenac on post-herniorrhaphy pain management. Methods: In this prospective double-blind clinical trial, 60 patients who were candidate for the surgical repair of inguinal hernia were divided into two groups. Patients in group A received 100 mg of suppository diclofenac and patients in group B 50 mg of pethidine after the induction of anesthesia and before surgical incision. Postoperative pain assessment was done by an unbiased observer on the arrival of patients in the recovery room, using a 10-cm visual analogue scale (VAS) at 2-hour intervals for 6 hours. Results: Pain relief was similar in the two groups (P=0.3). Patients in group B required more analgesia two hours post-operatively (P=0.03), while patients in group A had more favorable results regarding pain control (P<0.05). Statistically, there was no difference between the two groups at other intervals. The occurrence of nausea and vomiting was similar in both groups. No respiratory depression was observed in the patients. Conclusion: Preventive analgesia with 100 mg of suppository diclofenac after anesthesia induction for herniorrhaphy produced effective postoperative analgesia with minimum side-effects

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Shoulder pain is a common complication of cerebrovascular accidents.  This study was conducted to assess the effects of local injections of bupivacaine and triamcinolone acetate on shoulder joint pain and on restricted range of motion following brain events.
Methods: This single-blind clinical trial study included 35 patients with chronic shoulder pain (the controls) and 35 patients with chronic shoulder pain due to brain events (the case group). The study was done at Imam Hossein Hospital & Gandhi Day Clinic during the year 2008-2010. The patients in the two groups received bupivacaine and triamcinolone acetate for subacromial bursa injection and suprascapular nerve block by following the protocol described by Dangoisse et al. The patients were followed up for 12 weeks and they were evaluated for pain and range of motion 1, 6, and 12 weeks after the injections.
Results: The mean age of the patients was 60.9±9.07 years. Statistically significant improvements in pain score (P=0.001) and shoulder joint range of motion (P=0.001) were observed in patients with chronic shoulder pain versus patients with brain events 12 weeks after suprascapulare nerve block and subacromial bours injections by  bupivacaine and triamcinolone acetate.
Conclusion: Suprascapular nerve block and subacromial bursa injections of bupivacaine and triamcinolone acetate is a safe and efficacious treatment for the treatment of chronic shoulder pain and restricted range of motion but it is not efficacious or of significant value for the treatment of shoulder pain in patients with brain events.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Hemorrhoid is among the most common anorectal diseases and patients with high-grade disease conditions need surgical treatment. Many surgical procedures are available to treat the disease. The aim of this study was to compare the operative time and outcomes, (post-operative pain and complications) of LigaSure hemorrhoidectomy with those of the open conventional method.
Methods : This randomized single-blind clinical trial included 57 patients (28 in LigaSure and 29 in the open group). The primary variable was the operative time for the excision of a single hemorrhoidal packet. The other variables were post-operative pain measured by morphine doses administered to control pain, scores of visual analogue scale (VAS) used to measure pain severity, pain during home stay measured by doses of oral ibuprofen and the mean daily VAS scores, early complications including bleeding and urinary retention, longer-term complications and time to return to work.
Results : The demographic data were comparatively the same between the two groups. The average time to excise a single packet of hemorrhoid was significantly shorter in the LigaSure group (8.91 min vs. 17.35 min, P<0.001). Post-operative pain measurements (morphine doses and VAS scores) were lower in the LigaSure group, but the differences were not statistically significant (P=0.055 and 0.077, respectively). Complications of the two procedures were also comparable. Neither of the groups returned to work in a shorter time.
Conclusion: LigaSure hemorrhoidectomy seems to be a safe method and it can reduce the operative time significantly. It may also have a modest effect on post-operative pain.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Anterior knee pain is one of the most common complaints of patients in orthopedic clinics. The first step in the treatment of this problem is conservative treatment which includes administration of anti-inflammatory drugs, exercise and changes in life style. Many patients respond well to these measures in about six months, but a small number of patients may not respond to the conservative treatment therefore, surgical procedures such as Maquet osteotomy or lateral retinacular release may be needed in these cases. The aim of this study was to determine the efficacy of intraosseous drilling and decompression of patella in the treatment of chronic anterior knee pain.
Methods : This study was performed as a case series on ten patients with chronic anterior knee pain attending the Orthopedic Clinic of Imam Khomeini Hospital, in Tehran, Iran in 2009-2010. Eight of the patients were male and the rest were female. The patients met the inclusion criteria and were followed up for at least 12 months after the surgery.
Results : The mean age of the patients was 27.8±4.66 yr and their mean BMI was 22.5±1.71 kg/m². The mean pain severity before the interventions was 8.2±0.78 based on VAS but it decreased to 2.5±1.26 post-surgically. An average reduction of 5.7 scores were noticed in pain severity depicting a significant reduction of pain (P<0.0001).
Conclusion: It may be concluded that intraosseous drilling and decompression of patella is a safe and effective method in the treatment of chronic anterior knee pain not responding to conservative treatment.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Oral metronidazole has been previously demonstrated to decrease postoperative pain after open hemorrhoidectomy. The aim of this study was to evaluate the effect of topical metronidazole in reducing postoperative pain of hemorrhoidectomy.
Methods : In this double-blind, clinical trial forty 20- to 40-year old male patients were scheduled for hemorrhoidectomy under spinal anesthesia at the Imam Khomeini Hospital in Urmia, Iran from April to September 2010. The participants were assigned to receive topical metronidazole (n=20) or placebo (n=20). Pain intensity was assessed using a visual analog scale (VAS), the time of first narcotic request and morphine administrations were also recorded.
Results : The VAS scores were lower in metronidazole than the control group but this difference was not statistically significant, except after 24 hr post-surgically. Morphine administration in the first 24 hr was lower in the metronidazole group (P<0.05).
Conclusion: Although metronidazole could not prolong the time of first analgesic request, but application of metronidazole gel is associated with lower analgesic requirement.

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Background: Stretching exercises and massage therapy are both suggested for pain relief in fibromyalgia syndrome. Previous studies have not proved their superiority over each other. This study compared the therapeutic effects of friction massage, stretching exercises, and analgesics on pain relief in patients with fibromyalgia syndrome.
Methods: We evaluated 129 female patients with the diagnosis of primary fibromyalgia visited at the physical medicine clinics of Baqiyatallah Hospital in Tehran, Iran during 2010- 2011. Patients were randomly divided into three groups: the first group received 400 mg ibuprofen P.O. (3 times per day) and 25 mg nortriptyline (daily) P.O. as analgesic, the second group was treated by friction massage and the third group performed stretching exercises. Patients were assessed three times (initially, after one and four weeks) by visual analogue scale (VAS).
Results: The mean age of participants was 60.46 years. The mean age in each treatment group was 46.66 years in medication group, 46.73 years in stretching group and 46.65 years in friction massage group. Changes in VAS score over 4 weeks were 2.4, 3.1 and 1.9, in the first, second, and third groups, respectively. The changes in VAS were significantly different in the first and second groups rather than the controls (P<0.05).
Conclusion: The effect of stretch exercise on pain relief was similar to analgesics, but it was more effective than friction massage. Moreover, the therapeutic effect of stretching exercise on pain relief upon four weeks was more permanent than friction massage but it was similar to analgesics.

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Background: McGill pain questionnaire is the most useful standard tools for assessing pain. McGill pain questionnaire contains 78-word descriptive of the 20 subclasses form-ing in three main sensory, affective and evaluative domains. Due to cultural differences, the questionnaire has been translated into several languages. This study aimed to transl-ate MPQ into Persian language and assess its reliability, validity and acceptability in patients with cancer.
Methods: The study performed in Medical Oncology Department of Cancer Institute in Imam Khomeini Hospital in the Spring 2012. After translation of MPQ by two experts fluent in English, Persian version was returned to English. Then that backward transla-tion was compared with the original questionnaire and words that did not match were reviewed.  Patients with different types of cancer who suffering from chronic pain were admitted in our study. They did not receive any kind of pain killer drugs during the pre-vious 24 hours. There was no restriction of age, sex, education, type of cancer or treat-ment modality. The reliability and validity of Persian-McGill pain questionnaire after interviewing patients was assessed by test–retest reliability and internal consistency (Cronbach’s alpha).
Results: In total, 84 patients were interviewed and 30 patients who were available after 24 hour with the same condition recomplete the questionnaire. Cronbach’alpha of each domain was in 0.622-0.743 and total Crobach’s alpha (n=84) was 0.85. Evaluative aspect has only one subgroup and because of this, it is not have Crobach’s alpha. The stability coefficient (n=30) in all areas (sensory, emotional, and other domains) were 0.812-0.964. Stability coefficient among the 20 Persian McGill Pain Questionnaire (PMPQ) subclasses showed significant and reliable relationships over time for all groups.
Conclusion: This study is the first study that assessed psychometric properties and use-fulness of the MPQ in Iranian patients with cancer, showed that it is a potentially useful measure with a high validity and reliability standards.

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Background: The request for lumbosacral MRI in Iran  based on previous studies is high (almost half of all MRI cases), so, our study is concerned with investigating the necessity of lumbosacral MRI request in patients with low back pain that is covered by  complementary health insurance in Tehran through comparing  MRI practice with valid guidelines.
Methods: Information of 274 complementary insured patients at Dana Insurance Company in Tehran, who had undergone low back MRI was studied. A portion of information in the questionnaire including age, sex, the physician’s field of specialty, and MRI report, was derived from the medical records. Other information based on guidelines indications, including duration of the prolonged back pain, record of associated infection, malignancy or trauma, saddle anesthesia, lower limb motor deficit and incontinence of urine or feces, was elicited from patients orally.
Results: Males represented 35% and females 65% of patients. Also, males were on average 10 years younger than females. Over 90% of MRI scans were requested by three fields of specialty (orthopedic, neurosurgery and neurology). Considering the indications of lumbar spine MRI request (prolonged back pain of more than one month duration, incontinence of urine or feces, lower limb motor deficit, saddle anesthesia, recent related trauma, infection and malignancy), approximately 20% of lumbar spine MRI scans were prescribed in accordance with guidelines.
Conclusion: Out of every five cases of lumbar spine MRI, four cases were not requested based on guidelines, suggesting needs for local guideline design and revising the manner in which MRI scans are prescribed for low back pain in complementary health insured patients in Tehran.

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Background: Ischaemic pain counts among the most difficult to treat pains in palliative care. Ischemic pain is frequently severe, and usually resistant to available analgesics. Treatment of this condition is difficult, especially when the condition is inoperable.
Case presentation: A 36-year-old woman with the diagnosis of systemic lupus erythematosus with severe ischemic pain in the lower leg due to vascular problems presented to Akhtar Hospital. The patient was arranged for lumbar sympathetic block which was performed in two stages with one week interval. In the procedure, a long needle with No. 22 gauge and the length of 15 cm was used. Under view of fluoroscopy guide, 10 cc marcaine 0.125% was injected. In the second stage, 5 cc of marcaine 0.25% and 5 cc of phenol 0.6% were used. Pain improvement was observed immediately after neurolytic lumbar sympathetic block. Three-month follow up period revealed improvement of quality of life.
Conclusion: Lumbar sympathetic block is considered as a safe and useful technique. Clinically, the technique is effective for pain relief in patients who develop lower leg pain due to vasculitis.

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Background: Laparoscopic cholecystectomy is a way of removing the gallbladder. But like other surgeries, this procedure has some side effects such as postoperative shoulder pain. This study evaluates the effect of different gas flow rates into the abdominal cavity on postoperative shoulder pain in laparoscopic cholecystectomy patients. Methods: The study as a randomized clinical trial was conducted on laparoscopic chol-ecystectomy patients in Imam Khomeini Hospital- Esfarayen 2011-2012. One hun-dred participants were selected by available sampling, and were divided randomly into two groups of 50 patients. In group I flow rate of CO2 gas was two liters per minute and in group II flow rate of CO2 gas was five liters per minute. After reversing anesthe-sia, six, 12 and 24 hours post operative, shoulder pain was evaluated by Visual Ana-logue Scale (VAS) pain questionnaire. The study findings analyzed by independent t-test. Results: The mean age of participants was 48.8±7.5 years and mean surgery duration was 36.5±13.1 minutes, and there was no significant differences between two groups (P>0/05). However, the mean shoulder pain scores in group I (blowing with low pres-sure) was differed significantly with group II (blowing with high pressure) (P<0.05). In group I, pain was lower than group II. Conclusion: Results showed if CO2 gas flow rate is two liters per minute (blowing with low pressure), the patients complain less shoulder pain. Therefore low pressure gas in-sufflation for laparoscopic surgery is recommended. Further studies in this field should be considered.

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Background: Wrist arthroscopy is an evolving diagnostic and therapeutic modality which is progressively used by Iranian surgeons. Little data is published about the procedure’s indications, outcomes, complications and prognostic factors. In following study we evaluate the outcome and complications of diagnostic and therapeutic arthroscopy in our patients. Methods: In a prospective study from September 2009 to March 2013, 100 patients entered in the study. All the patients had chronic wrist pain without any sign of improvement despite at list three months non-operative treatment and underwent diagnostic and therapeutic wrist arthroscopy. All patients were evaluated by wrist range of motion, visual analogue scale (VAS), the quick-disabilities of the arm, shoulder and hand (Q-DASH), and Mayo wrist functional score before and after arthroscopy. Patients were visited at 3, 6, 12 weeks intervals after surgery and every six months thereafter. The most frequent diagnoses were triangular fibrocartilage complex (TFCC) injury, dorsal wrist ganglion cyst and Kienbock disease which were treated with accordant arthroscopic methods. Major and minor complications of arthroscopy and prognostic factors were evaluated. Results: Eighty nine patients participated in long term follow-up. The follow-up duration was 19±13 months. At final fallow-up there were 28.6±9.6 degrees improvement in wrist range of motion, 5.1±3.4 reduction in VAS score (P<0.04), 37.9±30 improvement in Mayo functional wrist score (P<0.02) and 47.5±33 reduction in Q-DASH score (P=0.009). 82% of patients were satisfied with postoperative results and 16% experienced recurrence. The preoperative diagnosis was not a prognostic factor for outcome of arthroscopic treatment. The rate of postoperative complications was 31.4%, which most of them were minor and transient complications. The most frequent complication of wrist arthroscopy in our patients was transient hypoesthesia in superficial ulnar nerve territory. Conclusion: According to our results, wrist arthroscopy have acceptable outcome in TFCC injuries and Kienbock disease. With the ever-expanding list of indications and procedures that can be performed with wrist arthroscopy, it can be considered as an essential diagnostic and therapeutic tool for the orthopedic surgeon.

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Background: Sciatic pain in association with lumbar disc herniation may require surgical intervention in the form of lumbar discectomy. Yet, the optimal time for this operation has not been specified in medical literature. Methods: In a Cross-sectional study, 147 patients (100 men and 47 women) with radiological and clinical signs of L4-L5 or L5-S1 disc herniation were entered to our registry prior to March 2009. They were all examined, diagnosed and operated on (lumbar discectomy) in Ghaem General Hospital, Mashhad, Iran. Patients were all subsequently followed for one year. The follow-up continued in a number of 126 cases, whose satisfaction was rated via phone interview for an extra year. The patients’ assessments were implemented employing three scaling systems, both before and following lumbar discectomy, to name the Modified Oswestry Disability Index (MODI), Visual Analogue Scale (VAS) and Prolo Functional Economic Outcome Rating Scale (PORS). The former two were used for pre-operative and post-operative assessments whereas the latter was applied during the first year of follow-up. The focus of the investigation during second year was on patients’ satisfaction. Results: Mean age of our cases were 34±7.4 years. According to the duration of the sciatica, patients were divided into 4 groups. <3 months, 3 to <6 month, 6 to <12 months and >12 months. Statistical analysis revealed a significant difference between patients having undergone lumber discectomy with a history of sciatica for less and more than three month before the operation in terms of pre-and post-operative visual Analogue Scale (P= 0.022). However, there could be found no such disparity in other clinical scores (P= 0.63 for MODI, P= 0.85 for Prolo scale and P= 0.73 for satisfaction). Conclusion: Patients with less than three months of sciatica may seem to enjoy a better clinical outcome after one year, there could be found no correlation between the duration of sciatica and the satisfaction after two years.

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Background: Recent studies have indicated the relation of vertebral endplate lesions (Modic changes) to low back pain (LBP). The aim of this study was to investigate the Modic changes in magnetic resonance imaging (MRI) of patients with low back pain, and its correlation with age, sex, type of changes, number of involved segments and location of changes. Additionally, association of degenerative disc changes and disc herniation was assessed.

Methods: In this retrospective study, MRI records of 229 patients with LBP referring to Medical Center of Hazrat-e-Rasoul Hospital, Tehran, Iran, from August to February 2014, were assessed and Modic changes and degenerative and herniated disc changes were recorded.

Results: Based on our observations, a significant association between Modic type and age (P= 0.003) existed in patients with LBP. The highest prevalence in Modic location were observed in anterior part of vertebral endplate (48.8%, P= 0.001). Although, observation of the Modic changes in superior vertebral endplate was higher than inferior parts, but this differences was not statistically significant. The highest prevalence in degenerative disc disease was disc dehydration which was observed in 18.1% of patients (P= 0.04). The relationship between the degenerative changes and Modic type was significant (P= 0.04), while the most prevalent change of disc contour was disc bulging which occurred in 23.7% of patients (P= 0.01). The highest frequency of abnormal disc contour were observed in Modic type 2 which was statistically significant (P= 0.01). Modic surface involvement above 25% was significantly associated with disc herniation (P= 0.04). There was no significant association between Modic height involvement above 25% and disc herniation.

Conclusion: Considering significant association between Modic changes and degenerative and herniated disc changes, reporting of Modic changes is necessary.

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Background: Coronary artery disease is considered as main factor for patients’ hospitalization. Chest pain is the most common symptoms of patients and its assessment is an important factor in coronary artery disease. So, this study aimed to determine the relationship between the severity of chest pain with physiological indexes in patients with coronary artery disease.

Methods: This study was a descriptive-analytical design that performed on 80 patients with that were hospitalized in coronary care unit of Shahid Mofatteh Hospital in Varamin city, Iran, from March to September, 2014. In this study, the relationship between the chest pain severity and blood pressure, pulse rate, respiratory rate, O₂ saturation and ST segment alterations were assessed. Finally, the gathered data were analyzed by descriptive and inferential statistics.

Results: The mean of chest pain severity was 6.51±2.14 in patients. Patients’ age was between 26 to 85 years old and the mean of age was 60.79±13.79 and there was no significant correlation between age and chest pain severity (P=0.985). Also male and female patients were equal. There was no significant difference between chest pain severity of men and women (P=0.471). The findings of study showed no correlation between chest pain severity and heart rate (r=-0.174 and P=0.122), respiratory rate (r=-0.013 and P=0.909), O₂ saturation (r=0.051 and P=0.651), ST segment alterations (r=0.07 and P=0.539). Also, there was no significant difference between chest pain severity and systolic pressure (P=0.353), diastolic blood pressure (P=0.312) and body mass index (P=0.256) among patients.

Conclusion: In this study, there were not enough evidences for relation between chest pain and physiological indexes in patients with coronary artery disease. So performing more studies in another settings and conditions recommended.

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Background: To examine the association among pelvic girdle pain (PGP), urinary incontinence (UI) and pelvic floor muscle (PFM) function in pregnant women in second and third trimester.

Methods: 300 pregnant women who admitted for standard pregnancy care were enrolled in the study. Urinary incontinency was measured via the international consultation on incontinence questionnaire short form. Pelvic girdle pain was diagnosed according to existing guidelines. Vaginal examination assessed pelvic muscles contract- relax patterns and muscle strength. The software stata version 13 (Stata Corp., TX, USA) was used for data analysis.

Results: Overall 300 women (150 with PGP and 150 without PGP) were included in final analyses. There was not significant differences between the demographic data including, body mass index before pregnancy, maternal age, mode of delivery. Prevalence of urinary incontinence in women with pelvic girdle pain was 41.5 percent (CI 95%: 32.01- 51.48) while the prevalence of urinary incontinence in women without pain was 21.9 percent (CI 95%: 14.99-30.03). Using logistic regression, the relationship between urinary incontinence and pelvic girdle pain was significant. (CI 95%: 1.07-3.31, P=0.02). Multivariate logistic regression analysis was used to evaluate the relationship between PGP and pelvic floor muscle function and results showed that pelvic floor muscle strength in women with PGP was significantly lower than women without PGP. (CI 95%: 0.24-0.68, OR= 0.4, P<0.001). The duration of the contraction of the pelvic floor muscles in patients with PGP was significantly shorter than women without PGP. (CI 95%: 0.21-0.60, OR =0.35, P<0.001).

Conclusion: There was a significant association between pelvic girdle pain and urinary incontinence during the second and third trimesters of pregnancy and also the pelvic floor muscle strength and duration of the contraction of the pelvic floor muscles in women with pelvic girdle pain was significantly lower than those without PGP.

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Background: Body pain in multiple sclerosis (MS) is a common phenomenon that can create or exacerbate by different parameters of clinical, psychological and demographic. The aim of this study was to investigate the relationship between parameters of clinical (fatigue, clinical course, body mass index and duration), psychological (depression, anxiety and stress) and demographic (age, gender, marital status and education) characters with multiple sclerosis patient’s body pain. Methods: This cross-sectional study has been performed in the Multiple Sclerosis Society of Guilan Province and Imam Reza Specialized and Sub-specialized Clinic, Rasht City, Iran during June to February 2010. In this study 162 patients with MS were selected by consecutive sampling. We used the clinical and demographic variables inventory, body pain subscale of the health survey questionnaire, depression, anxiety and stress scale and fatigue severity scale along with identical analog-spring balance. The data were analyzed by Pearson correlation coefficient and point bi-serial, one-way analysis of variance, Gabriel test and stepwise multiple regression. Results: The findings showed that patients who scored 3 or higher in relapses experienced significantly more body pain than patients who scored 1-2 times of relapses (P= 0.031). In the meantime, significant differences were not found between the two groups of patients with a score of 3 or higher in relapses and non-relapse and between non-relapse patients and with a score 1-2 times of relapses in terms of body pain. Also, significant differences were not found in different groups of hospitalization in terms of body pain. However, anxiety and fatigue together could explain significantly 25% of the shared variance of body pain (F= 26.29, P≤ 0.0009). Conclusion: This study showed the effect of psychological and clinical factors on body pain exacerbation in MS patients. Therefore, it is necessary for clinicians to consider identifying these factors and the relationships of the factors with increasing pain in patients with MS.

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