Introduction: Cesarean section is considered essential for protecting both the mother’s and fetus’s health. Nevertheless, in spite of being one of the safest surgical methods, cesarean section is more dangerous for mothers than vaginal delivery. According to WHO’s report, almost 15% of the deliveries can correctly lead to cesarean. However, statistics during the previous decade show a noticeable increase in the rate of cesarean. In many cases, cesarean is not a medical necessity. According to a number of studies, pregnant women prefer not to tolerate the PAIN that, in turn, leads to the main cause of increasing tendencies to voluntary cesarean. Having knowledge about PAIN reducing methods can, therefore, decrease such tendencies.Materials and Methods: This cross-sectional analytical study was conducted on 390 pregnant women referring to the public health centers of Mashhad. They filled out a questionnaire about personal and obstetric information, the kind of delivery they preferred (vaginal or cesarean), and their knowledge about PAIN RELIEF methods of delivery.Results: The findings show that the study groups, i.e. those participants who favored cesarean and those who preferred vaginal delivery, showed no significant difference in age, education, and job. The main causes of tendency to vaginal delivery were found to be the fear of anesthesia and surgery as well as willingness to see the newborn immediately after giving birth. The fear of vaginal delivery PAIN and the physician’s diagnosis were the main causes of voluntary cesarean. 80.80% of the participants were not aware of the PAIN reducing methods of baby delivery.Conclusion: As suggested by the findings, the main reason for having cesarean is the fear of vaginal delivery. However, the findings also suggest that the patients are not sufficiently aware of PAIN RELIEF methods due to the lack of access to the adequate information being provided by the delivery centers. It seems that raising women’s knowledge about delivery PAIN reducing methods and their benefits can decrease their tendencies to voluntary cesarean.

Background: Thoracotomy is one of the surgical operations which causes severe PAIN. In fact, this PAIN is one of the most excruciating PAINs caused by surgical operations. Different procedures are performed to decrease this PAIN which is associated with significant physiologic, mental and pathologic complications. Each of these procedures has its own advantage and disadvantages. In many centers, the most common treatment method used, is considered as the first choice. In this study, common methods of analgesia after thoracotomy were compared. Materials and Methods: During this meta-analysis, "Visual Analogue Scale" (VAS) of patients in epidural group was compared with those in four groups of systemic opioids, intercostal block, para- vertebral block and intrapleural infusion in the first 24 hours after surgery. Data obtained from 28 randomized clinical trials (RCT) which compared the procedures in 1697 patients after thoracotomy were gathered using random effect model, effect size index and the standardized difference average. Statistical values were evaluated and the results obtained using standard error, 5% maximum confidence limit and 5% minimum confidence limit. The obtained data were evaluated using studies performed between 1987 and 2005. After evaluating 314 titles and 185 abstracts, 28 articles were entered in the meta- analysis considering inclusion criteria. Four groups of epidural with systemic opioids, epidural with para-vertebral, epidural with intercostal and epidural with intrapleural analgesia were studied. Results: It was noticed that the epidural method in total 24 hours with 95% CI= -0.9802 to -0.3844 was a better procedure compared with systemic opioids. Epidural method did not show any difference with intercostals method in 24 hours mean with 95% CI= -0.2171 to +0.5906. Epidural method was also better than intrapleural in 24 hours mean with 95% CI= -1.1166 to-0.0106. When comparing epidural with para-vertebral, epidural was better with 95% CI= +0.1744 to -0.4527. Conclusion: According to the evaluations performed, epidural method is recommended as the method of choice to reduce PAIN after thoracotomy.      

Dear Editor: It is with great interest that I read the research article by Dr. Mogadam and colleagues: Comparison of Analgesic Effect between Gabapentin and Diclofenac on Post-Operative PAIN in Patients Undergoing Tonsillectomy (1). This randomized controlled trial of 90 patients undergoing tonsillectomy attempts to underline the importance of preemptive analgesia. This involves the beginning of an analgesic regimen before the onset of a noxious stimulus to prevent central sensitization and limit the subsequent PAIN experience (2).

Introduction: The effect of acupuncture in PAIN RELIEF has been determined. This study was designed with the aim of abstraction the factors which cause to use acupuncture for PAIN RELIEF.Methods: This qualitative study was a kind of conventional content analysis and was composed of 14 patients and acupuncture providers which were selected by purposeful sampling and the variety of age, education, sex, kind of PAIN among patients and having work experience among acupuncture providers were considered. Information was collected by deep and semi-structured interview. The method of data analyze was content analyze with inductive approach. The acceptance and exactness of data was repeatedly performed with modulation in data collection, the variety of participants, review and repeated overview of data, review the participants and members of survey team.Results: final results of the survey were 5 themes including: A) limitations in common medicine with major categories: the complexities of treatment, side effects of standard medication, lack of improvement, low satisfaction B) effectiveness of acupuncture with major categories: the characteristic of acupuncture, being natural and academic, the cost of effectiveness C) outer promoters with major categories: interaction of standard medicine and acupuncture, supportive sources, the way of introduction, the role of media D) inner promoters with major categories: individual characteristics, health condition E) inhibition in acupuncture with major categories: doubt in impact, opposition with use, performance barriers.Conclusions: Knowing the reasons of choosing acupuncture by patients, to be relived from PAIN which includes limitations in common medicine, effectiveness of acupuncture, outer promoters, inner promoters, inhibition in acupuncture, we can step forward with principal planning to develop some of the reasons and eliminate the barriers to make acupuncture more applicable.