Introduction: Colonoscopy is a painful and invasive technique for patients especially for pediatrics. Peppermint has analgesic effect. Therefore, we wish to look at the effect of peppermint essence on the patients&rsquo; satisfaction and pain after colonoscopy.  Methods: This clinical trial study was performed on 100 patient&rsquo;s candidate for colonoscopy. Patients were randomly divided into two groups. Control group received no drug. Case group was administrated supermint essence thirty minutes before colonoscopy. A valid questionnaire was filled during the colonoscopy for patient&rsquo;s satisfaction and pain evaluation.   Results: The mean value of abdominal pain was 0.527&plusmn;2.500 in control group and 1.625&plusmn;0.491 in case group after treatment (p&lt;0.05). Degree of satisfaction was 8 and 17.6 percent in control and case groups, respectively. Mean value of satisfaction in control group was 1.833&plusmn;0.389 that was significantly different from case group (2.607&plusmn;0.566) (p&lt;0.05). Duration of colonoscopy in control group was significantly higher than the one in case group (p&lt;0.05).  Conclusion: Our findings showed that peppermint essence causes an increasing in satisfaction as well as a reduction in pain in patients under the colonoscopy.</p

Ahanchian, Hamid.

Ghayour Mobarhan, Majid.

Jafari, Seyed Ali.

Khodadad, Ahmad.

Kiani, Ebrahim.

Kiani, Mohammad Ali.

Mohammadi, Shabnam.

Saeidi, Masumeh.

shahrekord university of medical scinces

Journal of HerbMed PharmacologyJournal homepage: http://www.herbmedpharmacol.com                J HerbMed Pharmacol. 2013; 2(2): 41-44.Effect of peppermint on pediatrics’ pain under endoscopic examination of the large bowel*Corresponding author: Shabnam Mohammadi, Department of Basic Sciences, Faculty of Medicine, Gonabad University of Medical Science, Gonabad, Iran. E-mail: mohammadi.s@gmu.ac.ir Mohammad-Ali Kiani1, Ahmad Khodadad2, Shabnam Mohammadi3,*, Majid Ghayour Mobarhan4, Masumeh Saeidi5, Seyed Ali Jafari1, Ebrahim Kiani6, Hamid Ahanchian71Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran2Department of Pediatrics, School of Medicine, Tehran University of Medical Science, Tehran, Iran3Department of Basic Sciences, Faculty of Medicine, Gonabad University of Medical Science, Gonabad, Iran; and Neurogenic Inflammation Research Centre, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 4Biochemistry of  Nutritional Research Center, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran 5Students Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran6Department of Pediatric, Islamic Azad University, Mashhad, Iran7Department of Pediatric, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IranIntroduction: Colonoscopy is a painful and invasive technique for patients especially for pediatrics. Peppermint has analgesic effect. Therefore, we wish to look at the effect of peppermint essence on the patients’ satisfaction and pain after colonoscopy.  Methods: This clinical trial study was performed on 100 patient’s candidate for colonoscopy. Patients were randomly divided into two groups. Control group received no drug. Case group was administrated supermint essence thirty minutes before colonoscopy. A valid questionnaire was filled during the colonoscopy for patient’s satisfaction and pain evaluation. Results: The mean value of abdominal pain was 0.527±2.500 in control group and 1.625±0.491 in case group after treatment (p<0.05). Degree of satisfaction was 8 and 17.6 percent in control and case groups, respectively. Mean value of satisfaction in control group was 1.833±0.389 that was significantly different from case group (2.607±0.566) (p<0.05). Duration of colonoscopy in control group was significantly higher than the one in case group (p<0.05).Conclusion: Our findings showed that peppermint essence causes an increasing in satisfaction as well as a reduction in pain in patients under the colonoscopy.    A B S T R A C TA R T I C L E  I N F OKeywords:ColonoscopySupermintPainPeppermintArticle History:Received: 1 October 2013Accepted: 20 November 2013ePublished: 1 December 2013Article Type:Original ArticleImplication for health policy/practice/research/medical education:Supermint reduces pain and increases satisfaction in patients under the colonoscopy and its consumption might be beneficial in these patients.Please cite this paper as: Kiani MA, Khodadad A, Mohammadi S, Ghayour Mobarhan  M, Saeidi M,  Jafari  SA, et al. Effect of peppermint on pediatrics’ pain under endoscopic examination of the large bowel. J HerbMed Pharmacol. 2013; 2(2): 41-44.Introduction Nowadays, colonoscopy is a standard and valuable method that widely used in the early diagnosis of colorectal mucosal lesions (1). Colonoscopy is a procedure for examining the colon by a thin, flexible tube with a camera. Colonoscopy usually takes 20-30 minutes that the main concerns are fear and pain during colonoscopy of children. Considering that many anti-anxiety and pain killer drugs are unsuitable for to children; it is necessary to find out a way to reduce children’s pain and anxiety during colonoscopy. Plant extracts are used for relieve of pain in traditional medicine. Several studies have reported the positive effects of herbal medicines worldwide, especially. It consists the hopeful effects of medicinal plants in various ailments, including pain (2-4), addiction (5,6), diabetes (7-9), and cancer (10,11). These plants may also be used to remove toxicity of synthetic drugs (12-14). In spite of suitable climate of Iran for growing the plants, limited researches have been conducted about plants. Peppermint is an aromatic herb, with a spicy and cooling taste that grows in different regions of Iran. Peppermint has analgesic, anti-bacterial, carminative and anti-inflammatory effect. Peppermint essence contains chemicals, including Kiani MA et al.42 Journal of HerbMed Pharmacology, Volume 2, Number 2, December 2013 http://www.herbmedpharmacol.com    trpinolen, osmyn, terpinene and Mentyl (15,16). Oral drop of supermint oil is a new carminative drug that its essence is provided with the scientific name Mentha spikata. This product contains 5.9 caron per ml of extract (17). Several studies have shown that peppermint extract reduces pain in patients with irritable bowel syndrome (18-21). Kingham found that peppermint oil is effective in colonic spasm (22). This study was aimed to evaluation the effect of peppermint essence on patients’ satisfaction and pain after colonoscopy in Children’s Medical Center, Tehran.  Materials and Methods This randomized clinical trial study was done on 100 children who referred to Children Medical Center in Tehran from May 2012 to September 2013. Children were randomly divided into two equal groups. Inclusion criteria were the aged 7-14 years, suspected polyps, intestinal disease or unknown bleeding (23). Exclusion criteria were lack of mental health, consciousness, using anti-anxiety and pain killer drugs. Patients were randomly divided into two equal groups of control and case, thirty minutes before surgery. Control group did not receive any drugs. Colonoscopy was performed under Toronto protocols. Children in case group received 20 ml oral supermint oil drop (Baryj Essence Company, Iran) 30 minutes before colonoscopy. After that, pain pediatric questionnaire was filled by an observer who was blinded to grouping of the patients. Scores were as follows: 0= no pain/1, 2= very weak pain/3, 4= weak pain/5, 6= mild pain/7, 8=severe pain/9, 10=very severe pain. Satisfaction Questionnaire consisted twelve questions (9 questions with five options of Likert scale (1= poor, 5= excellent), and the three questions were yes and no. Score 3 or higher was optimal for each question. Validity of questionnaires was approved by 10 members of the expert team and the reliability was calculated using alpha Cronbach method. The coefficient was calculated to be r= 0.88 for the questionnaire. Data were analyzed using SPSS statistical software version 11.5 and descriptive and analytical tests (Man Whitney, T-test). Significant level was considered at P<0.05. ResultsThe statistical analysis showed no significant difference in age distribution of two groups [10.13±2.85 (case group) versus 9.08 ± 2.55 (control group). P> 0.05]. Twenty-one patients in case group (41.17%) and 19 patients in the control group (38%) were female and data analysis showed no significant difference between the two groups (P> 0.05).  Mean value of pain was 2.5±0.52 out of 10 in control group and this value was 1.62±0.49 out of 10 in case group after treatment. Comparison values of pain was not found difference between two groups  after treatment (P<0.05; Table 1). As can be seen in Table 2, 17.6% (9 patients) in case group and 8% (4 patients) in control group had high degree of satisfaction. Mean degree of satisfaction in case group was 2.60±0.56. Statistical analysis showed significantly difference between case and control groups (2.60±0.56 vs. 1.83±0.38, respectively).Discussion Our results showed that administration of oral Supermint oil drops (peppermint oil) increased patients’ satisfaction after colonoscopy. Studies showed that peppermint causes relaxation of muscles (24). Vejdani and colleagues concluded that the use of peppermint extract reduced pain in patients with irritable bowel syndrome following eight weeks consumption (25). The results of the studies showed that peppermint affects on calcium channels in neurons for reducing calcium ions in neurons. It reduces pain via neuronal excitability and synaptic transmission (26). It has been reported that peppermint oil reduces contractions of smooth muscles during colonoscopy or barium enema (27). In a study in Sheffield College reported that using mint reduces Table 1.  Abdominal pain scores in patients under colonoscopy in case and control groupsGroupsDuration of abdominal painLess than one minute   One to three minutes 3-5 Minutes More than five minutesControl group 12(23.5%)25(49%)10(19.6%)3(5.8%)Case group 32*(64%)10(20%)7(14%)1(2%)*P<0.05 significantly different compared with control group.Table 2. Satisfaction scores in patients after colonoscopy in case and control groupsGroups Moderate Good Very good Excellent Case group 2 (3.9%) 25 (49%) 15* (29.4%) 9* (17.6%)Control group 12 (24%) 28 (56%) 6 (12%) 4 (8%)*P<0.05 significantly different compared with control group.Effect of peppermint on pediatrics’ pain43Journal of HerbMed Pharmacology, Volume 2, Number 2, December 2013http://www.herbmedpharmacol.com    pain relief and increases patients satisfaction in patients with irritable bowel syndrome (28). In a randomized clinical trial study, administration of peppermint oil capsules to 65 adult patients reduced spasms during colonoscopy. In addition, satisfaction levels increased dramatically after colonoscopy (29). In another study, mint oil was administered orally to 215 patients. Two hundred and fifteen patients were adopted as control group and administered no mint. The results showed that oral administration of peppermint reduced spasms in the esophagus, the lower part of the stomach, duodenal bulb compared to the control group. In addition, it improved the quality of diagnosis without the use of anti-spasmodic drugs (30). Similarly, in our study the administration of peppermint reduced colon spasms and increased satisfaction in patients as well as physician. Another study compared the effects of antispasmodic drug hyoscine and glucagon and peppermint oil on upper gastrointestinal endoscopy. Results showed that peppermint oil relieved spasm during endoscopy of the esophagus, stomach and duodenum in elderly patients (31). In our study, administration of peppermint oil was effective in reducing pain and satisfaction of patients and physician and no adverse effect was observed in the current study.ConclusionOur findings demonstrated that peppermint essence had a positive effect on satisfaction and reduction of pain in pediatrics under colonoscopy. The mechanism effect of peppermint may be related to reduction in colon spasms during colonoscopy or it may affect calcium channels in neurons to reduce calcium ion entry to neurons. AcknowledgementsAuthors wish to thank the Tehran University of Medical Sciences for financial support.Authors’ contributionsMAK, SAJ and AK carried out experiments and participated in design of the study. EK and HA participated in the coordination of the project, revised and approved the manuscript. MGM, SM and MS helped in draft the manuscript. Conflict of interestsThe authors declared no competing interests.Ethical considerations Ethical issues (including plagiarism, misconduct, data fabrication, falsification, double publication or submission, redundancy) have been completely observed by the authors.Funding/SupportNone.References 1. Bechtold ML, Perez RA, Puli SR, Marshall JB. Effect of music on patients undergoing outpatient colonoscopy. World J Gastroenterol 2006;12(45):7309-12.2. Rafieian-Kopaei M, Sewell RDE. Opioid tolerance and K ATP channel mediated antinociception. Analgesia 1995; 1(4-6): 667-670.3. Alibabaei Z, Pilehvarian AA, Shirani M, Kheiri S, Taji F, Asgari A, et al. Effect of Euphorbia helioscopia on acetic acid-induced abdominal constrictions in Balb/c mice. Shahrekord Univ Med Sci J 2010;11(Suppl.1): 9-14.4. Rafieian-Kopaei M, Sewell RDE. Newer antideprassants: Analgesia and relative monoamine reuptake inhibitory potency. J Pharm Pharmacol 1994;46 (Suppl.2):1088.5. Rafieian-Kopaei M, Sewell RDE. Morphine tolerance and SSRI antinocieeption. J Psychopharmacol 1995;9(3): A23-91.6.  Rafieian-Kopaei M, Sewell RDE. Opioid tolerance and K ATP channel mediated antinociception. Analgesia. 1995; 1(4-6), 667-670.7. Behradmanesh M, Ahmadi M, Rafieian-kopaei M. Effect of Glycogol on blood glucose level of patients with type II diabetes. Iran J Endocrin Metab 2012; 14(2):163-168. 8. Shamsi F, Asgari S, Rafieian R, Kazemi S. Effects of Cornus mas L. on blood glucose, insulin and histopathology of pancreas in alloxan-induced diabetic rats. J Isfahan Med School 2011;29(147):927-937.9. Behradmanesh S, Horestani MK, Baradaran A, Nasri H. Association of serum uric acid with proteinuria in type 2 diabetic patients. J Res Med Sci 2013; 18:44-6.10. Shirzad H, Shahrani M, Rafieian-Kopaei M. Comparison of morphine and tramadol effects on phagocytic activity of mice peritoneal phagocytes in vivo. Int Immunopharmacol 2009;9(7-8):968-7011. Shirzad H, Taji F, Rafieian-Kopaei M. Correlation between antioxidant activity of garlic extracts and WEHI-164 fibrosarcoma tumor growth in BALB/c mice. J Med Food 2011;14(9):969-74.12. Asgary S, Kazemi S, Moshtaghian SJ, Rafieian M, Bahrami M, Adelnia A. The protective effect of Cucurbita pepo L. on liver damage in alloxan- induced diabetic rats. Shahrekord Univ Med Sci J 2010;11(Suppl.1):59-65.13. Kazemi S, Asgari S, Moshtaghian SJ, Rafieian-kopaei M, Mahzooni P. Preventive effect of pumpkin (Cucurbita Pepo L.) on diabetic index and histopathology of pancreas in alloxan-induced diabetes in rats.  J Isfahan Med School 2011;28(117): 872-81.14. Shamsi F, Asgari S, Rafieian R, Kazemi S. Effects of Cornus mas L. on blood glucose, insulin and histopathology of pancreas in alloxan-induced diabetic rats. J Isfahan Med School 2011;29(147):927-937.15. Younis YMH, Beshir SM. Carvone-Rich Essential Oils from Mentha longifolia (L.) Huds. ssp. Schimperi Briq and Mentha spicata L. Grown in Sudan. JEOR 2004;16: 539-541.16. Zeinali H, Arzani A, Razmjoo R, Rezaee MB. Evaluation of Oil Compositions of Iranian Mints (Mentha ssp.). JEOR 2005;17:156-159.17. Velag J, Studulaj J. Medical Plants. Translation by Zaman S. Tehran: Ghoghnus;2000. p.3.18. Liu JH, Chen GH, Yeh HZ, Huang CK, Poon SK. Enteric-coated peppermint oil capsule in the treatment of irritable bowel syndrome a prospective, randomized trial. J Gastrorentrol 1997;32:765-8.19. Merat S, Khalili S, Mostajabi P, Ghorbani A, Ansari R, Malekzadeh R. The effect of enteric-coated, delayed-Kiani MA et al.44 Journal of HerbMed Pharmacology, Volume 2, Number 2, December 2013 http://www.herbmedpharmacol.com    release peppermint oil on irritable bowel syndrome. Dig Dis Sci 2010;55(5):1385-90. 20. Ford AC, Talley NJ, Spiegel BM, Foxx-Orenstein AE, Schiller L, Quigley EM, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ 2008;337:a2313. 21. Goerg KJ, Spilker T. Effect of peppermint oil and caraway oil on gastrointestinal motility in healthy volunteers: a pharmacodynamic study using simultaneous determination of gastric and gall-bladder emptying and orocaecal transit time. Aliment Pharmacol Ther 2003;17(3):445-51.22. Kingham JG. Peppermint oil and colon spasm. Lancet 1999; 98:346.23. Walker-Smith S. Colonoscopy and Enteroscopy, 5th Edition of Pediatric Gastrointestinal Diseases. Ed Walker, Durie, Hamilton. London. 2007,110.24. Nafisi A. Properties of food and Beverages among Various nations over the Centuries and ages. Esfahan: Esfahan University of Medical Sciences; 1990.25. Vejdani R, Shalmani HR, Mir-Fattahi M, Sajed-Nia F, Abdollahi M, Zali MR, et al. The efficacy of an herbal medicine, Carmint, on the relief of abdominal pain and bloating in patients with irritable bowel syndrome: a pilot study. Dig Dis Sci 2006;51(8):1501-7. 26. Takayuki Asao, Erito Mochiki, Hideki Suzuki, Jun-ichi Nakamura, Isao Hirayama, Nobuhiro Morinaga, et al. An easy method for the intraluminal administration of peppermint oil before colonoscopy and its effectiveness in reducing colonic spasm. Gastrointest Endosc 2001; 53 (2):172-7.27. Hiki N, Kurosaka H, Tatsutomi Y, Shimoyama S, Tsuji E, Kojima J, et al. Peppermint oil reduces gastric spasm during upper endoscopy: a randomized, double-blind, double-dummy controlled trial. Gastrointest Endosc 2003;57:475-482.28. Sparks MJW, O’Sullivan J, Herrington AA,  Morcos SK. Does peppermint oil relieve spasm during barium enema? Br J Radiol 1995;68:841-843.29. Shavakhi A, Ardestani SK, Taki M, Goli M, Keshteli AH. Premedication with peppermint oil capsules in colonoscopy: a double blind placebo-controlled randomized trial study. Acta Gastroenterologica Belgica 2012; 75(3):349-353.30. Mizuno S, Kato K, Ono Y, Yano K, Kurosaka H, Takahashi A, et al. Oral peppermint oil is a useful antispasmodic for double-contrast barium meal examination. J Gastroenterol Hepatol 2012;75(3):349-353.31. Imagawa A, Hata H, Nakatsu M, Yoshida Y, Takeuchi K, Inokuchi T, et al. Peppermint oil solution is useful as an antispasmodic drug for esophagogastroduodenoscopy, especially for elderly patients. Dig Dis Sci 2012; 57(9):2379-84. 

Effect of peppermint on pediatrics&rsquo; pain under endoscopic examination of the large bowel

http://eprints.skums.ac.ir/4803/1/102.pdf

Effect of peppermint on pediatrics’ pain under endoscopic examination of the large bowel

Abstract

Similar works

Full text

Available Versions

shahrekord university of medical scinces

Effect of peppermint on pediatrics&rsquo; pain under endoscopic examination of the large bowel

Abstract

Similar works

Full text

Available Versions

shahrekord university of medical scinces

Effect of peppermint on pediatrics’ pain under endoscopic examination of the large bowel