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944 DOCTORS' ATTITUDES AND BELIEFS TO PATIENTS WITH CHRONIC LOW BACK PAIN
S244
European Journal of Pain 2006, Vol 10 (suppl S1)
941 USEFULNESS OF THE NETHERLANDS CLASSIFICATION OF PAIN (NCP) IN CLINICAL PAIN RESEARCH M.J. van Leeuwen1 ° , L.M. Frederix-Wolters2 , B.J. Crul1 , P.F. de Vries Robb´e3 . 1 Pain Knowledge Centre, Radboud University Nijmegen Medical Centre, Nijmegen, 2 Division of Perioperative and Emergency Care, University Medical Centre Utrecht, Utrecht, 3 Department of Medical Informatics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Introduction: Informatics is a growing area in health care and needs standardized medical vocabularies. This is one of the reasons why The Netherlands Classification of Pain (NCP) has been developed. The NCP provides health-care professionals and researchers with a standardized terminology to describe the multidimensional aspects of pain. In clinical pain research it is also important to have standardized terminology because it improves the comparability and exchangeability of research data from scientific publications. We investigated the usefulness of the NCP-terminology in clinical pain research regarding content coverage. Methods: The study was based on 6792 terms drawn from Case Report Forms (CRF’s) from two clinical pain trials in the field of neuromodulation and lumbosacral radiofrequency lesioning. These terms were compared with NCP-terms on the level of concepts. Similarities and differences were determined in several classes only for unique concepts. Results: Of the 1143 unique concepts identified, 18% are identical, 17% are missing and 63% are more specific than the appropriate NCP-term, 2% less so. Missing concepts in the NCP are e.g. diagnostic investigations, pain symptoms and diagnoses and treatment complications. Anaesthesiological procedures and aspects of pain perception such as degree and duration of pain are described in more detail. Conclusions: The NCP insufficiently covers terminology used in clinical pain research. The question to which level of detail these terminologies should be unified has to be addressed before implementing unification with NCP. 942 P.A.I.N. QUALITY – OUTCOME DRIVEN PAIN MANAGEMENT B.J. Morlion1 , H. Walch2 , D.J. Vermeij3 , M. Stanton-Hicks4 , J. De Andres5 , G. Yihune6 ° . 1 Dept. for Pain Management, UZ Gasthuisberg, Leuven, Belgium, 2 Dept. of Anaesthesiology, LKH Graz-West, Graz, Austria, 3 Dirk Vermey Quality Management, Wijk bij Duurstede, The Netherlands, 4 Pain Management Center C-25, The Cleveland Clinic Foundation, Cleveland OH, USA, 5 Multidisciplinary Pain Management Departments, Valencia University General Hospital, Valencia, Spain, 6 International Healthcare Management, Gruenenthal GmbH, Aachen, Germany Background and Aims: Chronic pain is a major healthcare problem. Appropriate pain management is still not available to the majority of patients. Our objective is to elaborate feasible and outcome-orientated concepts to implement continuous quality control in routine clinical practice. Methods: A group of pain specialists, healthcare management experts, computer programmers and quality management consultants has developed a generic management tool for use in routine practice. The concept is based on a core data set suitable to standardise the clinical decision process, its outcome and the quality of care delivered. A client-server concept should enable valid quality comparisons between participating pain centers. A feasibiliy test is designed to evaluate the concept in five European pain centers. Results: P.A.I.N Quality – as tool for standardised documentation of routine care has been developed. It offers continuous clinical assessment by decision oriented documentation, individual case tracking and analysis of patient cohorts. Statistical key data from participating centres can be compared in an anonymous external ranking (benchmarking) to identify best practice. As a practical feature the software offers an automatic report generator. Conclusions: P.A.I.N. Quality intends to create a learning environment, able to perform continuous quality improvement. Scientific analysis of
Abstracts, 5th EFIC Congress, Free Presentations reality based data will support the development of validated practice based guidelines. It addresses pain interested professionals, professional scientific pain societies as well as healthcare policymakers and is a step towards effective and economic pain management in clinical practice.
G07 META-ANALYSIS AND SYSTEMATIC REVIEWS 943 PREVALENCE OF CANCER PAIN: A META-ANALYSIS J.M. de Rijke1 ° , M.H.J. van den Beuken1 , A.G. Kessels1 , H.C. Schouten2 , M. van Kleef1 , J. Patijn1 . 1 Pain Management and Research Centre, Dept of Anaesthesiology, 2 Dept of Oncology, University Hospital Maastricht, University Maastricht, The Netherlands Background amd Aims: Despite the abundant literature on this topic, accurate prevalence estimates of pain in cancer patients are not available. We investigated the prevalence of pain in cancer patients according to the different disease stages and types of cancer. Methods: A systematic review of the literature published in the years 1966–2005 was conducted. An instrument especially designed for judging prevalence studies on their methodological quality was used. Methodological acceptable articles were used in the meta-analyses. Results: Hundred and sixty studies were analysed using the methodological criteria. Fifty-two studies were used in the meta-analysis. Pooled prevalence rates of pain were calculated for four subgroups: 1: studies including patients after curative treatment: 33% (95% confidence interval (CI) 21−46%); 2: studies including patients under anti-cancer treatment: 59% (CI 44−73%); 3: studies including patients characterised as advanced, metastatic or with terminal disease: 64% (CI 58−69%) and 4: studies including patients at all disease stages: 53% (CI 43−63%). Of the patients with pain more than one-third graded their pain as moderate or severe. Pooled prevalence of pain was more than 50% in all cancer types with the highest prevalence in head/neck cancer patients (70%; 95% CI 51−88%). No differences between pain prevalence rates were found in relation to period of publication, continent, mean age of the study population, definition of prevalence, validated or non-validated questionnaires. Conclusion: Despite the fact that the WHO ladder has been introduced 20 years ago, cancer pain still is a major problem. This applies for cancer patients in all stages.
944 DOCTORS’ ATTITUDES AND BELIEFS TO PATIENTS WITH CHRONIC LOW BACK PAIN B. Fullen1 ° , G. Bury2 , L. Daly3 , D.A. Hurley1 . 1 UCD School of Physiotherapy and Performance Science, Dublin, 2 UCD School of Medicine and Medical Science, Dublin, 3 UCD School of Public Health and Population Science, Dublin, Ireland Numerous factors influence Doctors’ decision making in the treatment plan for patients with low back pain (LBP): personal experience, education and knowledge of the evidence. Despite a body of literature within this field no systematic review has been undertaken. Thus, this study aimed to conduct a systematic review of the literature regarding the attitudes and beliefs of Doctors to patients with LBP. The selection criteria included qualitative or quantative studies involving LBP and Doctors, written in English and published between January 1990April 2006. An electronic search of databases was carried out (Medline, EMBASE, Psychinfo, BIOSIS, Cinahl and the Cochrane Central Register of Controlled trials). Bibliographies of identified articles were also searched. Search terms used included: low back pain, doctor, general practitioner, rheumatologist, attitude, belief, education, knowledge, recommendations, and patient expectations. Relevant abstracts were screened and relevant papers were reviewed independently by two reviewers. Disagreement was resolved by a third reviewer. Quality rating was determined by internal and external validity and the quality of the reporting.
Topic G: DIAGNOSIS, ASSESSMENT AND REVIEWS Fifty-seven papers were initially identified: impact of education (N = 28), influence of Doctors characteristics (N = 5), influence of patient’s expectations (N = 8) and satisfaction (N = 4), interpersonal relationship with the Doctor (N = 4), Doctors perception of the patients’ pain (N = 5) and external factors e.g. employers (N = 3). Doctor’s attitudes and beliefs have important health and financial implications for both the patient and the health service. The findings of this systematic review will inform a national survey of medical practitioners’ attitudes to LBP. 945 REFLEX SYMPATHETIC DYSTROPHY SYNDROME OF THE LOWER EXTREMITY AFTER SPINAL CORD INJURY (CASE REPORT) A. Kurtaran ° , B. Sel¸cuk, N. Sulubulut, M. Aky¨uz, M. Ers¨oz. Ankara Fizik Tedavi Ve Rehabilitasyon Egitim Ve ArastıRma Hastanesi, Ankara, Turkey Background and Aims: Reports of SCI patients with RSDS are rare and most of these reported cases involve upper extremities in tetraplegic patient. Our case, presents and discusses a patient with RSDS involving lower extremity. Method: A 31 year old female patient presented herself with bladder and rectal dysfunction, difficulty walking and leg pains. Patient was involved in a car accident two months prior to symptoms and diagnosed with a L-1 vertebral burst fracture. Both lower extremity joints had free movement capability but, left extremity had edema, hyperemia and pain on palpation at the dorsal side of the foot and pain by motion or palpation at the knee. Related to the patients painful picture, to differentiate the diagnosis from deep vein thrombosis (DVT), heterotopic ossifications (HO), RSDS and stress fractures, direct bone graphies, Doppler ultrasonography, three phasic radionuclide syntigraphy of the involved bones, were requested. Three phasic radionuclide syntigraphy also revealed increased activity compatible with RSDS at left knee and foot. Whirlpool and massage to this extremity was initiated and calcitonin 100 IU/24h IM was started. Conclusions: As being a rarely seen problem, our case which is similar to the other reported rare cases of post MSI lower extremity RSDS, once again reinstates the importance to consider this syndrome among the other diseases with similar symptoms within this group of patients, careful evaluation of other possible causes and early, aggressive treatement of the problem for a complete remission and prevention of permanent complications might later develop.
946 A META-ANALYSIS OF QUALITATIVE RESEARCH ON PATIENTS’ EXPERIENCES OF CHRONIC PAIN A. Willman1 , B. Sj¨ostr¨om2 ° . 1 School of Health Science, Blekinge Institute of Technology, Karlskrona, 2 University of Sk¨ovde, School of Life Sciences, Sk¨ovde, Sweden Aim: To make a meta-analysis of research with qualitative methods on patients’ experiences of chronic pain. Methods: A systematic search in Medline and CINAHL in February, 2003, identified studies concerning patients experiences of chronic pain. Patients with back pain, abdominal pain, cancer pain, migraine or postoperative pain were excluded. All together, 154 full-text documents were analysed in two steps. First they were all assessed for quality and scientific rigor after a specific developed assessment tool. Secondly, results from studies ranking high and medium in scientific quality, and with similar methodological point of departure, were categorised using a classical inductive, qualitative research approach. Results: The results from the analysis show that there are five main areas, which characterizes problematic areas for patients suffering from chronic pain. These areas are: The painful body with the principal themes: Pain in itself, Fatigue and Sleep disturbances. The second main area is The search to reduce suffering with the themes: Self-control, Medicine and Diagnosis. The third is: Struggling for dignity with the themes: Loss of freedom, Loss
S245 of integrity and Existence. The fourth is The imposed reorientation and the fifth is Mediation of the experience of suffering from chronic pain. Conclusions: The findings suggest that the patients’ experiences of chronic pain are focused on the pain itself but also on the consequences of longterm pain for human living. It is of utmost importance that professionals are able to take into account the individual patient’s experiences and integrate this with previous professional experience. G08 PAIN EPIDEMIOLOGY 947 CRANIOMANDIBULAR DISARTICULATION, A HIDDEN CAUSE FOR COMPLEX HEAD AND NECK PAIN AND DISORDERS R.A. Abdel-Fattah ° , M.M. Alattar. Private Practice, Boca Raton FL, USA The human mandible has a unique mechanical position located underneath the maxilla, a bone that is attached to the cranium and influence the function of the cranial bones. Distorted Craniomandibular articulation causes undue pressure and eventually symptoms such as persistent unexplained headache, earache, sinus-like pain, pain behind eyes]and dysfunction such as limitation of movement, difficult mastication, or disfigurement. In addition, the mandible is positioned anterior and superior to the cervical region influencing the Oropharynx that has vital live essential functions such as respiration, deglutition, and posture. Posterior mandibular displacement may be a causative factor in snoring, obstructive sleep apnea, unusual throat pain, difficult swallowing and or unrelenting neck pain, Unfortunately the assessment of the mandibular balance is not usually implemented in the neurological, orthopedic, or Otorhinolaryngological examinations. A short examination methods together with the needed diagnostic testing as well as some complex cases are to be presented.
948 HERBAL DRUGS AND DYSMENOREA P. Afshari ° , S. Sadeghi, F. Pazandeh. Nursing and Midwifery Faculty, Ahvaz Jondishapour Medical Sciences University, Ahvaz, Khozestan, Iran
Introduction: Painful menstruation is a cyclic painful condition that adversely affects the woman’s wellbeing for a large part of her life. Medication is usually required for all cases of moderate to severe painful menstruation. Apart from pharmacological agents, several techniques have been used including relaxation therapy, hypnosis, manipulation, psychotherapy, acupuncture, biofeedback techniques, and also using of herbal drugs the aim of this study was to determine frequency use of herbal drugs in university students. Material and Method: It was a descriptive study. We studied 215 female students in university in reproductive age (19−22 yrs). Data was collected through a self-administered questionnaire. Results: We found that the mean age of students were 20 yrs old. 24% of students use from herbal drugs. The most common drugs that they used were Carun carvi and Zataria multiflora boiss. They believed that medical drugs reduce their bleeding and it shows that may be having other side effects. All of the students believed that herbal drugs can reduce their pain as well as synthetic drugs. Conclusion: Herbal drugs can use for relief menstruation pain and educated and young people believed its benefits but we must tell them this drugs have side effect too.
European Journal of Pain 2006, Vol 10 (suppl S1)
941 USEFULNESS OF THE NETHERLANDS CLASSIFICATION OF PAIN (NCP) IN CLINICAL PAIN RESEARCH M.J. van Leeuwen1 ° , L.M. Frederix-Wolters2 , B.J. Crul1 , P.F. de Vries Robb´e3 . 1 Pain Knowledge Centre, Radboud University Nijmegen Medical Centre, Nijmegen, 2 Division of Perioperative and Emergency Care, University Medical Centre Utrecht, Utrecht, 3 Department of Medical Informatics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Introduction: Informatics is a growing area in health care and needs standardized medical vocabularies. This is one of the reasons why The Netherlands Classification of Pain (NCP) has been developed. The NCP provides health-care professionals and researchers with a standardized terminology to describe the multidimensional aspects of pain. In clinical pain research it is also important to have standardized terminology because it improves the comparability and exchangeability of research data from scientific publications. We investigated the usefulness of the NCP-terminology in clinical pain research regarding content coverage. Methods: The study was based on 6792 terms drawn from Case Report Forms (CRF’s) from two clinical pain trials in the field of neuromodulation and lumbosacral radiofrequency lesioning. These terms were compared with NCP-terms on the level of concepts. Similarities and differences were determined in several classes only for unique concepts. Results: Of the 1143 unique concepts identified, 18% are identical, 17% are missing and 63% are more specific than the appropriate NCP-term, 2% less so. Missing concepts in the NCP are e.g. diagnostic investigations, pain symptoms and diagnoses and treatment complications. Anaesthesiological procedures and aspects of pain perception such as degree and duration of pain are described in more detail. Conclusions: The NCP insufficiently covers terminology used in clinical pain research. The question to which level of detail these terminologies should be unified has to be addressed before implementing unification with NCP. 942 P.A.I.N. QUALITY – OUTCOME DRIVEN PAIN MANAGEMENT B.J. Morlion1 , H. Walch2 , D.J. Vermeij3 , M. Stanton-Hicks4 , J. De Andres5 , G. Yihune6 ° . 1 Dept. for Pain Management, UZ Gasthuisberg, Leuven, Belgium, 2 Dept. of Anaesthesiology, LKH Graz-West, Graz, Austria, 3 Dirk Vermey Quality Management, Wijk bij Duurstede, The Netherlands, 4 Pain Management Center C-25, The Cleveland Clinic Foundation, Cleveland OH, USA, 5 Multidisciplinary Pain Management Departments, Valencia University General Hospital, Valencia, Spain, 6 International Healthcare Management, Gruenenthal GmbH, Aachen, Germany Background and Aims: Chronic pain is a major healthcare problem. Appropriate pain management is still not available to the majority of patients. Our objective is to elaborate feasible and outcome-orientated concepts to implement continuous quality control in routine clinical practice. Methods: A group of pain specialists, healthcare management experts, computer programmers and quality management consultants has developed a generic management tool for use in routine practice. The concept is based on a core data set suitable to standardise the clinical decision process, its outcome and the quality of care delivered. A client-server concept should enable valid quality comparisons between participating pain centers. A feasibiliy test is designed to evaluate the concept in five European pain centers. Results: P.A.I.N Quality – as tool for standardised documentation of routine care has been developed. It offers continuous clinical assessment by decision oriented documentation, individual case tracking and analysis of patient cohorts. Statistical key data from participating centres can be compared in an anonymous external ranking (benchmarking) to identify best practice. As a practical feature the software offers an automatic report generator. Conclusions: P.A.I.N. Quality intends to create a learning environment, able to perform continuous quality improvement. Scientific analysis of
Abstracts, 5th EFIC Congress, Free Presentations reality based data will support the development of validated practice based guidelines. It addresses pain interested professionals, professional scientific pain societies as well as healthcare policymakers and is a step towards effective and economic pain management in clinical practice.
G07 META-ANALYSIS AND SYSTEMATIC REVIEWS 943 PREVALENCE OF CANCER PAIN: A META-ANALYSIS J.M. de Rijke1 ° , M.H.J. van den Beuken1 , A.G. Kessels1 , H.C. Schouten2 , M. van Kleef1 , J. Patijn1 . 1 Pain Management and Research Centre, Dept of Anaesthesiology, 2 Dept of Oncology, University Hospital Maastricht, University Maastricht, The Netherlands Background amd Aims: Despite the abundant literature on this topic, accurate prevalence estimates of pain in cancer patients are not available. We investigated the prevalence of pain in cancer patients according to the different disease stages and types of cancer. Methods: A systematic review of the literature published in the years 1966–2005 was conducted. An instrument especially designed for judging prevalence studies on their methodological quality was used. Methodological acceptable articles were used in the meta-analyses. Results: Hundred and sixty studies were analysed using the methodological criteria. Fifty-two studies were used in the meta-analysis. Pooled prevalence rates of pain were calculated for four subgroups: 1: studies including patients after curative treatment: 33% (95% confidence interval (CI) 21−46%); 2: studies including patients under anti-cancer treatment: 59% (CI 44−73%); 3: studies including patients characterised as advanced, metastatic or with terminal disease: 64% (CI 58−69%) and 4: studies including patients at all disease stages: 53% (CI 43−63%). Of the patients with pain more than one-third graded their pain as moderate or severe. Pooled prevalence of pain was more than 50% in all cancer types with the highest prevalence in head/neck cancer patients (70%; 95% CI 51−88%). No differences between pain prevalence rates were found in relation to period of publication, continent, mean age of the study population, definition of prevalence, validated or non-validated questionnaires. Conclusion: Despite the fact that the WHO ladder has been introduced 20 years ago, cancer pain still is a major problem. This applies for cancer patients in all stages.
944 DOCTORS’ ATTITUDES AND BELIEFS TO PATIENTS WITH CHRONIC LOW BACK PAIN B. Fullen1 ° , G. Bury2 , L. Daly3 , D.A. Hurley1 . 1 UCD School of Physiotherapy and Performance Science, Dublin, 2 UCD School of Medicine and Medical Science, Dublin, 3 UCD School of Public Health and Population Science, Dublin, Ireland Numerous factors influence Doctors’ decision making in the treatment plan for patients with low back pain (LBP): personal experience, education and knowledge of the evidence. Despite a body of literature within this field no systematic review has been undertaken. Thus, this study aimed to conduct a systematic review of the literature regarding the attitudes and beliefs of Doctors to patients with LBP. The selection criteria included qualitative or quantative studies involving LBP and Doctors, written in English and published between January 1990April 2006. An electronic search of databases was carried out (Medline, EMBASE, Psychinfo, BIOSIS, Cinahl and the Cochrane Central Register of Controlled trials). Bibliographies of identified articles were also searched. Search terms used included: low back pain, doctor, general practitioner, rheumatologist, attitude, belief, education, knowledge, recommendations, and patient expectations. Relevant abstracts were screened and relevant papers were reviewed independently by two reviewers. Disagreement was resolved by a third reviewer. Quality rating was determined by internal and external validity and the quality of the reporting.
Topic G: DIAGNOSIS, ASSESSMENT AND REVIEWS Fifty-seven papers were initially identified: impact of education (N = 28), influence of Doctors characteristics (N = 5), influence of patient’s expectations (N = 8) and satisfaction (N = 4), interpersonal relationship with the Doctor (N = 4), Doctors perception of the patients’ pain (N = 5) and external factors e.g. employers (N = 3). Doctor’s attitudes and beliefs have important health and financial implications for both the patient and the health service. The findings of this systematic review will inform a national survey of medical practitioners’ attitudes to LBP. 945 REFLEX SYMPATHETIC DYSTROPHY SYNDROME OF THE LOWER EXTREMITY AFTER SPINAL CORD INJURY (CASE REPORT) A. Kurtaran ° , B. Sel¸cuk, N. Sulubulut, M. Aky¨uz, M. Ers¨oz. Ankara Fizik Tedavi Ve Rehabilitasyon Egitim Ve ArastıRma Hastanesi, Ankara, Turkey Background and Aims: Reports of SCI patients with RSDS are rare and most of these reported cases involve upper extremities in tetraplegic patient. Our case, presents and discusses a patient with RSDS involving lower extremity. Method: A 31 year old female patient presented herself with bladder and rectal dysfunction, difficulty walking and leg pains. Patient was involved in a car accident two months prior to symptoms and diagnosed with a L-1 vertebral burst fracture. Both lower extremity joints had free movement capability but, left extremity had edema, hyperemia and pain on palpation at the dorsal side of the foot and pain by motion or palpation at the knee. Related to the patients painful picture, to differentiate the diagnosis from deep vein thrombosis (DVT), heterotopic ossifications (HO), RSDS and stress fractures, direct bone graphies, Doppler ultrasonography, three phasic radionuclide syntigraphy of the involved bones, were requested. Three phasic radionuclide syntigraphy also revealed increased activity compatible with RSDS at left knee and foot. Whirlpool and massage to this extremity was initiated and calcitonin 100 IU/24h IM was started. Conclusions: As being a rarely seen problem, our case which is similar to the other reported rare cases of post MSI lower extremity RSDS, once again reinstates the importance to consider this syndrome among the other diseases with similar symptoms within this group of patients, careful evaluation of other possible causes and early, aggressive treatement of the problem for a complete remission and prevention of permanent complications might later develop.
946 A META-ANALYSIS OF QUALITATIVE RESEARCH ON PATIENTS’ EXPERIENCES OF CHRONIC PAIN A. Willman1 , B. Sj¨ostr¨om2 ° . 1 School of Health Science, Blekinge Institute of Technology, Karlskrona, 2 University of Sk¨ovde, School of Life Sciences, Sk¨ovde, Sweden Aim: To make a meta-analysis of research with qualitative methods on patients’ experiences of chronic pain. Methods: A systematic search in Medline and CINAHL in February, 2003, identified studies concerning patients experiences of chronic pain. Patients with back pain, abdominal pain, cancer pain, migraine or postoperative pain were excluded. All together, 154 full-text documents were analysed in two steps. First they were all assessed for quality and scientific rigor after a specific developed assessment tool. Secondly, results from studies ranking high and medium in scientific quality, and with similar methodological point of departure, were categorised using a classical inductive, qualitative research approach. Results: The results from the analysis show that there are five main areas, which characterizes problematic areas for patients suffering from chronic pain. These areas are: The painful body with the principal themes: Pain in itself, Fatigue and Sleep disturbances. The second main area is The search to reduce suffering with the themes: Self-control, Medicine and Diagnosis. The third is: Struggling for dignity with the themes: Loss of freedom, Loss
S245 of integrity and Existence. The fourth is The imposed reorientation and the fifth is Mediation of the experience of suffering from chronic pain. Conclusions: The findings suggest that the patients’ experiences of chronic pain are focused on the pain itself but also on the consequences of longterm pain for human living. It is of utmost importance that professionals are able to take into account the individual patient’s experiences and integrate this with previous professional experience. G08 PAIN EPIDEMIOLOGY 947 CRANIOMANDIBULAR DISARTICULATION, A HIDDEN CAUSE FOR COMPLEX HEAD AND NECK PAIN AND DISORDERS R.A. Abdel-Fattah ° , M.M. Alattar. Private Practice, Boca Raton FL, USA The human mandible has a unique mechanical position located underneath the maxilla, a bone that is attached to the cranium and influence the function of the cranial bones. Distorted Craniomandibular articulation causes undue pressure and eventually symptoms such as persistent unexplained headache, earache, sinus-like pain, pain behind eyes]and dysfunction such as limitation of movement, difficult mastication, or disfigurement. In addition, the mandible is positioned anterior and superior to the cervical region influencing the Oropharynx that has vital live essential functions such as respiration, deglutition, and posture. Posterior mandibular displacement may be a causative factor in snoring, obstructive sleep apnea, unusual throat pain, difficult swallowing and or unrelenting neck pain, Unfortunately the assessment of the mandibular balance is not usually implemented in the neurological, orthopedic, or Otorhinolaryngological examinations. A short examination methods together with the needed diagnostic testing as well as some complex cases are to be presented.
948 HERBAL DRUGS AND DYSMENOREA P. Afshari ° , S. Sadeghi, F. Pazandeh. Nursing and Midwifery Faculty, Ahvaz Jondishapour Medical Sciences University, Ahvaz, Khozestan, Iran
Introduction: Painful menstruation is a cyclic painful condition that adversely affects the woman’s wellbeing for a large part of her life. Medication is usually required for all cases of moderate to severe painful menstruation. Apart from pharmacological agents, several techniques have been used including relaxation therapy, hypnosis, manipulation, psychotherapy, acupuncture, biofeedback techniques, and also using of herbal drugs the aim of this study was to determine frequency use of herbal drugs in university students. Material and Method: It was a descriptive study. We studied 215 female students in university in reproductive age (19−22 yrs). Data was collected through a self-administered questionnaire. Results: We found that the mean age of students were 20 yrs old. 24% of students use from herbal drugs. The most common drugs that they used were Carun carvi and Zataria multiflora boiss. They believed that medical drugs reduce their bleeding and it shows that may be having other side effects. All of the students believed that herbal drugs can reduce their pain as well as synthetic drugs. Conclusion: Herbal drugs can use for relief menstruation pain and educated and young people believed its benefits but we must tell them this drugs have side effect too.