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Background:Combining different analgesic drugs for improvement of drug efficacy is a recommended strategy intended to achieve the optimal therapeutic effects.Objectives:The purpose of the present study was to assess the nature of the interaction between ascorbic acid and two analgesic drugs, morphine and tramadol.Materials and Methods:The analgesic activity was assessed by the acetic acid writhing test in male Naval Medical Research Institute (NMRI) mice. The results were obtained using four to six animals in each group. All the drugs were injected intraperitoneally. The effective doses (ED) that produced 20%, 50%, and 65% antinociception (ED20, ED50 and ED65) were calculated from the dose-response curve of each drug alone as well as co-administration of ascorbic acid and tramadol or morphine. The interaction index was calculated as experimental ED/theoretical ED. For each drug combination, ED50, ED20 and ED65 were determined by linear regression analysis of the dose-response curve, and they were compared to theoretical ED50, ED20 and ED65 using t-test.Results:The antinociceptive effects of all drugs were dose-dependent (ED50was 206.1 mg/kg for ascorbic acid, 8.33 mg/kg for tramadol, and 0.79 mg/kg for morphine). The interaction index demonstrated additive effects at ED50 and ED65 for co-administration of ascorbic acid and tramadol or morphine. However, at ED20, combination of ascorbic acid and tramadol or morphine showed synergic effects. The interaction index values of the combinations demonstrated the potency ratio of ascorbic acid/morphine to be lower than ascorbic acid/tramadol.Conclusions:This study demonstrated the results of interactions between ascorbic acid and tramadol or morphine. The results showed that the interaction effects on antinociception may be synergistic or additive, depending on the level of effect.

Objectives Increasing age is associated with the risk of diseases and increased treatment problems. Due to the aging population and the need for consumption of drugs for chronic diseases of the elderly, understanding health challenges and treatment problems in the elderly is important. Based on this, a qualitative study was performed to identify treatment problems in older people's viewpoint in Hamadan . Methods & Materials This qualitative study was conducted by content analysis approach. Data were collected through semi-structured propound interview with 15 elderly people having an age average of 66.47±4.47 years, who were referred to health centers in Hamadan city in 2015. Data was gathered by sampling based sexes with a maximum variation of age range of 60 to 75 years, socioeconomic status, and educational level. All interviews were simultaneously handwritten. Data were analyzed using content analysis method. Data strength was confirmed by participants and researchers. Results Elderly patients had an average age of 66.47 years and a standard deviation of 4.47. Of the 15 participants, there were 6 females and 9 males. Data analysis resulted in extraction of 3 main themes "causes related to doctors, taking medication problems and shortage of drugs."These themes were determined by the following eleven subthemes: "the cost of visits to doctors, distrust of doctors, doctors not caring for the elderly, complications for the elderly, early completion medicines , efficacy, the absence of an alternative drug for existing drugs, many drugs for consumption, use of other drugs, lack of medicines in some pharmacies, and delivery of expired drugs to the elderly in some pharmacies". Conclusion The results showed that there are problems of treatment in elderly. So after reviewing the problems with appropriate interventions, training can guide and help the elderly in this area. The authorities can also use findings from research in planning. A B S T R A C T Key words:Qualitative study, Treatment measures, Drug, Elderly . Aging is directly related to non-communicable diseases, increased medication use and therapeutic problems [3,4]. Problems of medical procedure affect health, social and economic dimensions of the elderly [5]. Therefore, considering the importance and sensitivity of this issue as one of the challenges of national health system and the lack of appropriate scientific information about health issues of the elderly, this study was conducted to identify the problems of medical procedure from the viewpoint of the elderly referrals to healthcare centers of Hamedan during 2015. Methods & MaterialsThe present research was a qualitative study using qualitative content analysis [6] that was conducted on the elderly referrals to Hamedan healthcare centers in 2015. The research participants were selected through an objective-oriented sampling with maximum diversity. The study was approved by the Ethics Committee of Hamedan University of Medical Sciences with the code of ethics (UMSHA.REC.1394,2). Before the interview, the...

Background: Ascorbic acid is amongst important water-soluble vitamins and when used orally in high-doses it has been observed to relieve pain and reduce opioid use in patients. However no controlled trial has compared the antinociceptive effects of ascorbic acid with other analgesic groups on animal models, and investigated the involved mechanisms. Objectives: In the present study, the antinociceptive effect of vitamin C on male mice was investigated and compared with morphine and diclofenac. Also, possible mechanisms were assayed. Materials and Methods: Male albino mice were used in this study. Antinociception was measured using the writhing test, tail flick and formalin tests. Ascorbic acid was used in three doses (30, 150 and 300 mg/kg, IP) and compared with the antinociceptive effects of 10 mg/kg of morphine as an opioid analgesic agent and 5-10 mg/kg of diclofenac as a nonsteroidal anti-inflammatory drug (NSAID) analgesic agent. The antinociceptive effect of ascorbic acid (300 mg/kg) was compared before and after treatment with naloxone (4 mg/kg), ondansetron (0.5 mg/kg), atropine (5 mg/kg) and metoclopramide (1 mg/kg) in the writhing test. Results: Vitamin C caused dose-dependent antinociceptive effects in acetic acid writhing test (P < 0.05). It had no significant effect in the tail flick test. Meanwhile, vitamin C in high doses reduced pain in the second phase of the formalin test (P < 0.05). Morphine had higher nociceptive effects in comparison to ascorbic acid in the writhing test (P < 0.05). In the second phase of the formalin test the antinociceptive effects of vitamin C (300 mg/kg) was not significantly different with morphine at dose of 10 mg/kg. There was not significant difference between vitamin C (300 mg/kg) and diclofenac (10 mg/kg) in the second phase of the formalin test. Metoclopramide and ondansetrone reduced the antinociceptive effects of vitamin C. Conclusions:The results obtained from the acetic acid induced writhing test and second phase of the formalin test indicate that vitamin C possess antinociceptive activity especially on inflammatory pain. Ondansetrone and metoclopramide reduced the effects of ascorbic acid, which may be because ascorbic acid produced antinociception through mechanisms that may be involved in dopaminergic and serotoninergic systems.

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