Anesthetic and analgesic practices in Avicenna's Canon of Medicine

An overview of the effect of medicinal herbs on pain

This paper is typically intended to carefully collect and properly review the antinociceptive activities of medicinal plants. In this review article, by searching keywords of medicinal plants, pain, herbal medicine, antinociceptive, phytotherapy in databases of Web of Science, Scopus, Google Scholar, Springer, Wiley, Proquest, PubMed, Nature, Magiran, Emerald, SID, ISI, and some other indexing cites, or traditional books, desired articles were obtained until 2021. The title of medicinal plants was searched diligently in Persian and English. Ultimately, 270 articles were studied. The findings possibly indicated that several medicinal plants are among the most valuable plants that have antinociceptive activities. There efficiently are various antinociceptive compounds in medicinal plants. The antinociceptive activity of these specific compounds may be through their peculiar effects on the opioid system, cholinergic pathways, and stimulation of GABA receptors, with the peripheral and central antinociceptive mechanism. Antiinflammatory processes, inhibition of the synthesis, and the release of arachidonic acid, prostaglandins, phospholipase, nitric oxide, and cyclooxygenase-2 have been reported as analgesic mechanisms of some herbs. In a reasonable conclusion, our review thoughtfully provides a comprehensive summary of present data from some scientific studies on the common herbs with antinociceptive and antiinflammatory activities.

Insight into the possible mechanism(s) involved in the antinociceptive and antineuropathic activity of Descurainia sophia L. Webb ex Prantl essential oil

ETHNOPHARMACOLOGICAL RELEVANCE

Descurainia sophia (L.)(Brassicaceae), popularly known as "Khaksheer", is a native species widely distributed in Iran. The seeds and essential oil has been used in local traditional medicine (Persian folk ethnomedicine) to treat fever, inflammation, back pain, and headache.

AIM OF THE STUDY

To investigate in vitro anti-nociceptive and antineuropathic activities of Descurainia sophia seeds essential oil (DSEO) in rats and to determine the possible mechanism(s) involved.

MATERIALS AND METHODS

The antinociceptive activity of DSEO or Linolenic acid (LA) was evaluated using the formalin induced paw licking test followed by determination on the role of NO-cGMP-K+ channel pathway as well as a number of non-opioid receptor systems (vanilloid, dopamine, cannabinoid, serotonin, peroxisome proliferator activated, and adrenergic receptors) in the modulation of DSEO-induced antinociceptive activity. Additionally, the cervical spinal cord contusion (CCS) model was used to study antineuropathic potential of DSEO or LA.

RESULTS

DSEO exerted significant (p < 0.05) antinociceptive activity in formalin test (both phases) and altered mechanical allodynia and hyperalgesia observed in the CCS model. Pretreatment with glibenclamide, Nω-nitro-L-arginine methyl ester, tranilast, methylene blue, SCH23390, SR141716A and SR144528 restored DSEO-induced antinociceptive activity observed in the formalin test. Furthermore, LA also reduced nociceptive responses induced in the formalin and CCS models.

CONCLUSION

DSEO inhibits inflammatory mediated nociceptive response partly via the modulation of NO-cGMP-K+ channels pathway well as the activation of vanilloid, dopamine, and cannabinoid receptors, and exerts antineuropathic activity possibly via the modulation of inflammatory mediated activity. Thus, these findings confirm the Persian ethno-medicine claim on the efficacy of D. Sophia.

Physospermum cornubienseL. alleviates nociceptive and neuropathic pain: Evidences and possible mechanisms

ETHNOPHARMACOLOGICAL RELEVANCE

In Iranian/Persian folkloric medicine, Physospermum cornubiense (Shokaran Baghi in Persian) is used for the treatment of pain and inflammation.

OBJECTIVE

This modern examination included Swiss mice to investigate the anti-neuropathic and anti-nociceptive effects of Physospermum cornubiense essential oil (PCEO).

MATERIALS AND METHODS

To determine PCEO 's anti-nociceptive function in formalin-induced paw licking (FML) paradigm, researchers looked at the arginine-nitric oxide and potassium channels pathway in addition to involvements of more specific examples of receptors such as adrenergic, opioid, cannabinoid, peroxisome proliferator-activated (PPA), and transient receptor potential vanilloid. The CVC or cervical spinal cord contusion exemplar has also been used to induce neuropathic pain.

RESULTS

PCEO (450mg/kg) relative to control mice in the phase_ II of FML exemplar provided strong antinociception (p < 0.001). Furthermore, pre-treatments with arginine, glibenclamide, methylene blue, L-NAME, SNP, GW6471, naloxonazine, and GW9662 (p < 0.05) returned the PCEO antinociceptive response in the FML (inflammatory phase) model. Orally limonene administration significantly diminished (p < 0.001) acute pain in inflammatory phase of FML test. Moreover, the von Frey test indicated that both PCEO and limonene could return neuropathic pain (mechanical allodynia) in CVC mice.

CONCLUSION

The results obtained from this study, together with literature, give evidence of properties of PCEO for therapy of antinociceptive and neuropathic pain.

Artemisia biennis Willd.: Anti-Nociceptive effects and possible mechanisms of action

ETHNOPHARMACOLOGICAL RELEVANCE

Artemisia biennis Willd. (Dermane in Persian) has been used as an antinociceptive remedy in Iranian folkloric medicine.

OBJECTIVE

The aim of the present study was to evaluate the anti-nociceptive effects of Artemisia biennis Willd. aerial part essential oil (ABAEO) on male Swiss mice.

MATERIALS AND METHODS

Nociceptive pain techniques including acetic acid-induced writhing (AAIW), formalin-induced paw licking (FPL), glutamate-induced paw licking (GPL), and tail-flick (TF) models were applied. We assessed opioid and L-arginine-NO-cGMP-KATP pathways to detect the possible anti-nociceptive properties of ABAEO. In addition, neuropathic pain was induced by the cervical spinal cord contusion model.

RESULTS

ABAEO (120 mg/kg) had a significant anti-nociceptive activities in comparison to the control animals (p < 0.05) in the AAIW, TF, GPL, and FPL assays. The selective opioid antagonist (naloxonazine) administration in the AAIW test alleviated the anti-nociceptive effect of ABAEO (p < 0.05). L-arginine, methylene blue, and glibenclamide treatment prevented the ABAEO anti-nociceptive effects (p < 0.05); however, sodium nitroprusside could profoundly potentiate the ABAEO-associated antinociception in the FPL (phase II) test (p < 0.05). In nociceptive pain models, Cr (one of the main constituents of ABAEO) showed significant anti-nociceptive effects (p < 0.05). Moreover, the von Frey results indicated that ABAEO could attenuate mechanical allodynia in mice.

CONCLUSION

Our observation revealed the anti-nociceptive effects of ABAEO in male mice. These effects could include, at least in part, modulating glutamatergic mechanisms via opioid systems. Our data output also indicates activating the L-arginine-NO-cGMP-KATP system in ABAEO anti-nociceptive activities.

Antinociceptive activity of Cnicus benedictus L. leaf extract: a mechanistic evaluation

Background and purpose:

Cnicus benedictus, a medicinal herb, traditionally had been used for the treatment of stomachache pain. In this study, the possible efficacy of Cnicus benedictus leaf methanolic extract (CBHE) and also cnicin, one of its major constituents, was measured on pain.

Experimental approach:

In this study, pain assessment tests include writhing, tail-flick (TF), and formalin- induced paw licking test (FIPLT) were used. To understand the possible mediated anti-nociceptive mechanism of CBHE, the opioid mechanism(s), and involvement of the L-arginine/ nitric oxide/cGMP/ATP-sensitive potassium channel pathway (LNCaP) were scrutinized.

Findings/Results:

In TF and writhing tests, CBHE (150 and 300 mg/kg, i.p) remarkably exhibited an anti-nociceptive effect compared to that of the control. Furthermore, CBHE (150 and 300 mg/kg, i.p) in comparison with the control showed a noteworthy anti-nociceptive effect (P < 0.01) in the tonic phase of FIPLT. In the writhing test, administration of selective opioid antagonist (naltrindole, nor-binaltorphimine, and naloxonazine) attenuated the anti-nociceptive effect of CBHE (300 mg/kg) in comparison with control. Moreover, pre-treatment with Nω-nitro-L-arginine methyl ester hydrochloride, L-arginine hydrochloride, and glibenclamide significantly blocked the CBHE (300 mg/kg) anti-nociception (P < 0.05) while administration of sodium nitroprusside remarkably potentiated (P < 0.05) the antinociception induced by CBHE in the tonic phase of the FIPLT. Besides, cnicin (30 mg/kg) showed noteworthy anti-nociceptive effects in writhing, TF, and FIPLT paradigms.

Conclusion and implications:

Taken together, we elucidate that both CBHE and cnicin demonstrated antinociceptive effects in behavioral tests. The possible mechanisms of CBHE antinociception may involve in various neural signaling and modulatory pathways including LNCaP and opioidergic mechanisms.

Contributions of Avicenna to surgery and anesthesiology

Background: Avicenna, as the Persian physician has had a great contribution to the field of medical sciences, especially surgery in 10th and 11th centuries AD.Methods: In the present paper, a few translated quoted words of Avicenna were shared about his surgical practice. Indexing databases of PubMed and Google Scholar were searched using the keywords like Avicenna, surgery, and anesthesiology to find related papers and documents.Results: The first portion comprises of some most commonly used simple and compound herbal preparations to produce general and local anesthetics before the surgery and as dental anesthetic agents. In the second portion, practices regarding surgical management for skull fractures, spinal trauma, bone fracture, cataract, incurable urinary retention, bladder calculi, hemorrhoids, cancer as well as endotracheal intubation and tracheostomy have also been incorporated. Finally, it ends up with practices regarding the use of natural products as postoperative dressing for traumatic and surgical wounds and after cataract surgery.Conclusion: Findings of this review study will provide a brief insight on Avicenna's Canon of Medicine to the sciences of anesthesiology and surgery based on the recent investigations.

Galen's place in Avicenna's The Canon of Medicine: Respect, confirmation and criticism

Galen (129-199 A.D.), an ancient Greek scholar, is one of the most influential and recognized physicians and surgeons in the history of medicine. He is one of the most influential Greek scholar in Persian medicine, who has been repeatedly cited by Iranian scholars. The purpose of this article is to describe the exact position of Galen in Avicenna's The Canon of Medicine, the most important work of Persian medicine. In The Canon of Medicine, Galen is cited about 300 times, and Avicenna always admired and praised Galen repeatedly. Galen's ideas were important to Avicenna, but there are also many elements of Galen's views that Avicenna challenged or criticized. For example, Avicenna diverged from Galen's philosophical view in medicine and rejected some of Galen's pharmaceutical opinions and Galen's views on the physiology of pain, the physiology of pulse, the same nature of the tendons and nerves and separation of the mind and body. Although the views of Greek scholars, especially Galen, in The Canon of Medicine have been quoted abundantly, Avicenna revised the knowledge of the ancient scholars through critical thinking and relying on observation and testing, systematized the science of medicine and introduced many ideas and innovations. As such, Europeans considered Avicenna as the most prominent physician of the Islamic Golden Age.

Sagas of the Solanaceae: Speculative ethnobotanical perspectives on the Norse berserkers

ETHNOPHARMACOLOGICAL RELEVANCE

The Norse berserkers were wild warriors of Scandinavia known to enter a trance-like state that allowed them to fight with increased strength and a rage that granted them immunity to many forms of harm in battle. Though many theories have been advanced as to the cause of this state, the most widely believed is that the intoxicating mushroom Amanita muscaria was used.

AIM OF THE STUDY

The following article underlines the issues with this theory and provides an alternate intoxicant that fits with the reports of berserker behaviour much better: Hyoscyamus niger.

MATERIALS AND METHODS

Literature from a variety of disciplines pertaining to history, toxicology, pharmacology, and botany was compiled to frame and support the argument.

RESULTS

H. niger proved to be a more likely intoxicant used to induce the berserker rage state.

CONCLUSIONS

With its anticholinergic tropane alkaloids and symptom profile, H. niger is a much more likely cause of the berserker state than A muscaria. Though there is not enough archaeological and historical evidence to prove or disprove this theory, it provides a novel explanation that is at present the most viable means of understanding the berserkers' trance.

Antinociceptive activity of Inula britannica L. and patuletin: In vivo and possible mechanisms studies

ETHNOPHARMACOLOGICAL RELEVANCE

Inula britannica L. is a predominant medicinal plant traditionally utilized in the treatments of arthritis and back pain in Iranian folk medicine.

AIM OF THE STUDY

The purpose of this research was to evaluate the antinociceptive effects of Inula britannica L. flower essential oil (IBLEO) and one of its major constituents, Patuletin (Pn), in male mice.

MATERIALS AND METHODS

In this study, we used pain assessment tests including acetic acid-induced writhing, tail-flick (TF), formalin induced paw licking (FIPL) model, and glutamate-induced paw licking (GPL). For understanding the supposed antinociceptive mechanisms of IBLEO, opioid and L-arginine/NO/cGMP/ KATP pathways were examined.

RESULTS

In the TF, writhing, GPL, and FIPL tests, a dosage of 100 mg/kg of IBLEO showed noteworthy antinociceptive effects in comparison with control (p < 0.05). In writhing test, administration of selective opioid antagonists (naltrindole, nor-binaltorphimine, and naloxonazine) attenuated the antinociceptive effect of IBLEO in comparison with control (p < 0.001). Both methylene blue and glibenclamide blocked the antinociceptive effect of IBLEO (p < 0.05), but the administration of L-arginine or sodium nitroprusside fundamentally potentiated the antinociception induced by IBLEO in phase II of the FIPL (p < 0.05). Additionally, patuletin showed significant antinociceptive effects in writhing, FIPL, and GPL tests (p < 0.01).

CONCLUSION

The results of this examination showed that IBLEO and Pn have antinociceptive effects. The modulation of glutamatergic systems by opioid receptors could be involved, at least in part, in these effects. Our data also suggest the activation of the L-arginine/NO/cGMP/KATP pathway in IBLEO antinociceptive effects.

Protective effects of restricted diet and antioxidants on testis tissue in rats fed with high-fat diet

Background:

A high-fat diet (HFD) promotes the oxidative stress formation, which in turn has hazardous effects on reproductive system and fertility. The present study examines the potential positive effects of a restricted high-fat diet (RHFD) and antioxidants consumption on sperm parameters and testis tissue in rats.

Methods:

Male rats (n = 48) were divided into four groups (12 in each group): control group (Cont), HFD group, RHFD, and RHFD with astaxanthin and vitamins E and C group (RHFDA). After 12 weeks, serum analysis and sperm parameters study were performed. Sections of fixed testes were stained with Hematoxilin and Eosin to study the histological changes. A one-way ANOVA was used to compare the data.

Results:

HFD fed animals presented significant increase in weight load and serum low density lipoprotein (LDL-C) levels (P < 0.05). The sperm count in RHFD was lower than three other groups (P < 0.05) and sperm motility of RHFDA group was significantly higher than HFD and RHFD groups (P < 0.05). The histological study was showed a significant increase in spermatogonium number in RHFDA compared to three other groups (P < 0.05). The number of spermatocyte I and spermatid in RHFD was significantly (P < 0.05) lower than Cont and HFD groups.

Conclusion:

HFD and obesity can affect sperm parameters and spermatogenesis and antioxidants consumption may improve their quality. Although the RHFD is a benefit way in weight loss and decrease of LDL-C of serum, but it is suggested that is not effective on sperm quality improvement.

Topical treatment in pain medicine: from ancient remedies to modern usage

Over several millennia, substances have been applied to the skin for treatment of pain. Some ingredients are in current use; others have been discontinued. Mechanisms of action include interactions with nociceptive neural networks and inflammatory processes. Substances must penetrate the stratum corneum barrier and vehicles that enhance penetration have been developed. Topical drugs with links to the past include menthol, capsaicin, some opioids, local anesthetic agents and NSAIDs. Mandragora is also described as an example of a herbal remedy that has been discontinued due to its toxicity. The future for topical drugs is promising, with the advent of new drugs tailored for specific pain mechanisms and the development of both penetration enhancers and sterile preparation methods.

Historical essay: An Arabic surgeon, Ibn al Quff's (1232-1286) account on surgical pain relief

This is a review of Ibn al Quff's account of surgical pain relief in his surgical book Al Omdah, in which he mentioned the word anesthetic (Al moukhadder) and the involvement of physician (al tabbaaee) to give mixture of drugs to prevent pain in a surgical condition to relieve the patient from pain or to make surgical management possible. Hich indicated one rare occasion to such description in Arabic medical texts. Methods of administration of these drugs were inhalation, ingestion and by rectal suppositories. The drugs used in anesthetic sponges include all the drugs that are recorded in the modern literature of anesthesia. They are as follows: opium, mandrake, Hyocymus albus, belladonna, Cannabis sativus, Cannabis indica, wild lettuce. The anesthetic sponge, mentioned in many references as an inhalation method, may be of symbolic value to surgery.

Special article: mandragora: anesthetic of the ancients

Initial attempts at surgical anesthesia began many centuries ago, with the plants of antiquity. The mandragora, or mandrake, was used as a sedative and to induce pain relief for surgical procedures. It has been depicted in tablets and friezes since the 16th century before the common era (BCE) and used for its sedative effects by Hannibal (second century BCE) against his enemies. The Romans used the mandrake for surgery. The Arabs translated the scientific work of the Ancients and expanded on their knowledge. They developed the Spongia Somnifera, which contained the juice of the mandrake plant. After the fall of the Islamic cities of Europe to the Christians, scientific work was translated into Latin and the Spongia Somnifera was used in Europe until the discovery of the use of ether for surgical anesthesia.

Avicenna's concept of pain

Ibn Sina (Latin name – Avicenna, 980–1037) is a famous Muslim physician who wrote The Canon of Medicine. Pain-related writings within The Canon were identified and analysed and compared to Galen and Modern Pain Theory. We found evidence in The Canon that Avicenna challenged Galen's concept of pain. Galen insisted that injuries (breach of continuity) were the only cause of pain. In contrast, Avicenna suggested that the true cause of pain was a change of the physical condition (temperament change) of the organ whether there was an injury present or not. Avicenna extended Galen's descriptions of 4 to 15 types of pain and used a terminology that is remarkably similar to that used in the McGill Pain Questionnaire.

Functional anatomy of the spine by Avicenna in his eleventh century treatise Al-Qanun fi al-Tibb (The Canons of Medicine)

The history of spinal surgery is an important part of the spine-related sciences. The development of treatment strategies for spine-related disorders is acquired from the Western literature. In this article, an Eastern physician, Ibn Sina, who is known as Avicenna in the West, and his treatise, Al-Qanun fi al-Tibb (the Canons of Medicine), are presented. Eight chapters of this book regarding the functional neuroanatomy of the spine were reviewed and are presented to give insight into the development of the understanding of spinal anatomy and biomechanics.