Non-pharmacological Pain Control Research Articles

The effect of the Yakson and Gentle Human Touch methods applied to preterm infants during endotracheal aspiration on pain, comfort, and physiological parameters

BackgroundPreterm infants in the neonatal intensive care unit are exposed to various painful procedures; thus, different non-pharmacological pain control techniques are used to alleviate pain. ObjectivesThe aim of this study is to determine the effect of Yakson and Gentle Human Touch (GHT) methods during endotracheal suctioning on pain, comfort, and physiological parameters response in preterm infants. DesignA randomised controlled crossover trial. SettingThis study was conducted in the neonatal intensive care unit between July 2022 and June 2023. MethodsThirty infants were included in this study based on inclusion criteria. The samples randomly received a sequence of suctioning with Yakson and GHT and routine care. Neonatal Pain Agitation and Sedation Scale (N-PASS) and COMFORTneo were used to collect the data. ResultsThe pain and comfort scores of preterm infants who received GHT and Yakson touch during and after endotracheal suctioning were statistically significantly lower than the infants in the routine care (p < 0.001). It was determined that the difference was in favour of the Yakson group (p < 0.001). The infants who received GHT and Yakson application had lower heart rates and higher oxygen saturation levels after the application compared to the control group (p < 0.001). ConclusionThe application of Yakson and GHT during endotracheal aspiration in preterm infants has been found to be effective in pain and comfort management, as well as in the regulation of physiological parameters.

Comparative assessment between chewing gum, bite wafers, and ibuprofen in pain control following separators placement among orthodontic patients

ObjectiveThis study aimed to evaluate the efficiency of chewing gum and using bite wafers in reducing pain after the placement of separators in orthodontic patients and to compare that efficiency with ibuprofen use. Additionally, this study evaluated the effect of non-pharmacological pain control methods on the frequency of separators falling out. MethodsThe study sample comprised 105 female patients between 15 and 35 years of age. The patients were randomly selected and classified into three groups (35 each). Each group was given either ibuprofen, viscoelastic bite wafers, or chewing gum immediately after the placement of separators and every 8 h for 1 week, as needed. The patients were asked to record their pain perception using a visual analog scale following separator placement at 2 h, 6 h, bedtime, 24 h, and at 2, 3, and 7 days. Analysis of variance testing was used for the data analysis. ResultsAmong the three studied groups, there were no significant differences in pain perception at any time point. The patients experienced significantly higher pain scores at bedtime and 24 h after separator placement. In addition, there were statistically significant findings in pain perception at different time points within each pain relief method (p = 0.000, p < 0.05). ConclusionThe use of chewing gum and bite wafers in alleviating orthodontic pain was beneficial and comparable to ibuprofen use following the placement of separators before orthodontic treatment among orthodontic patients.

Practice of Nonpharmacological Pain Control Strategies Among Nurses Working in Public Hospitals of West Arsi Zone, Ethiopia.

Nonpharmacological pain control strategies combine numerous strategies that contain nondrug measures for pain remedies for sufferers. To assess the practice of nonpharmacological pain control strategies among nurses working in public hospitals of West Arsi zone, Ethiopia, 2022. An institutional-based cross-sectional study design was employed from April 15 to May 30, 2022. The total sample size was 422 and a simple random sampling technique was used. Data were entered using Epi-information 4.6 version and analyzed using SPSS version 25. Multicollinearity was checked by considering the variance inflation factor and tolerance. The goodness of fit test was done using the Hosmer-Lemeshow goodness of fit check. Binary logistic regression analysis was done and variables with a p-value of < 0.25 within the bivariable analysis were taken into the multivariable analysis. Statistical significance was declared at a p-value of < 0.05 with an adjusted odds ratio (AOR) and 95% confidence interval (CI). The practice of nonpharmacological pain control strategies was 53.8% (95% CI: 48.9-58.7). Age of 30-39 years old (AOR: 2.28, 95% CI: 1.34-3.86), educational status bachelor's degree (AOR: 2.25, 95% CI: 1.47-4.45), marital status married (AOR: 0.46, 95% CI: 0.28-0.73), and having training (AOR: 1.98, 95% CI: 1.23-3.17) were found to be significantly associated with practice of nonpharmacological pain control strategies. About five in 10 nurses working in West Arsi zone public hospitals had good practice of nonpharmacological pain control strategies. Age, educational status, marital status, and training were found to be significantly associated with practice. Therefore, improving the educational status of nurses through various opportunities such as continued professional development and regular updating, and training nurses about methods may increase the nurses' practice toward nonpharmacological pain control strategies.

Endorphin Massage on Intensity of Pain in the First Stage of Active Labour

Most maternity mothers feel pain during labor; the causes of pain in Indonesia is 16% because they experience complications, and 63% because they did not get information on childbirth preparation. Pain arises due to increased activity of the sympathetic nervous system and results in blood pressure and pulse. A midwife cannot provide analgetic in reducing pain, so complementary treatments are very helpful, one of which is endorphins massage. Massage therapy can systematically affect the skin surface, soft tissues, muscles, and ligaments. It can release of endorphin hormone that can cause muscle relaxation. This study aims to determine endorphin massage's effect on pain intensity in the first stage of active labor at Public Health Center Mampang Prapatan District, South Jakarta. This study used a quasi-experimental design with a pretest-posttest type of control group. This type involved two groups of subjects, one was treated (experimental group) with 15 samples, and the other was not treated (control group) with 15 samples. The total sample is 30 respondents. The research instrument used an observation sheet to measure pain intensity using the FLACC scale (Face, Legs, Activity, Cry, Consolability). Data analysis used the Wilcoxon signed rank test and the Mann-Whitney test. Based on the results of the Mann-Whitney test, it shows that the Assign value sig. (2-tailed) of 0.000. This means that 0,000 &lt; 0,05, there is a significant difference between the pain intensity of the experimental group that was given endorphin massage and the control group that was not treated. There is a difference between the pain intensity in the first stage of active labor at Public Health Center Mampang Prapatan, South Jakarta. It is recommended that services apply non-pharmacological pain control methods of endorphin massage in labor.

Efektivitas Pemberian Metode Pijat Oksitosin Dan Pijat Akupresur Terhadap Lama Persalinan Kala I Fase Aktif

Introduction: In Banten, in 2019 the cause of maternal death was recorded at 22,5% caused by other causes, one of which was due to prolonged labor, as well as Cimanggu Health Center in 2021 found 1 case of maternal death caused by bleeding the cause was due to prolonged parturition. One way to speed up the progress of labor is by giving oxytocin massage and acupressure massage. The purpose of the study was to determine the effectiveness of giving oxytocin massage and acupressure massage for the duration of the active phase of the first stage of labor at the Cimanggu Health Center, Pandeglang Regency, Banten in 2022. Methods: The research method was a quasi-experimental design with a post-test-only design with control groups, the number of samples was 60 respondents, the sampling technique was purposive sampling, and data analysis using the Independent T-test. Result: The results of the study showed that the duration of the first stage of active labor in the oxytocin massage group obtained an average of = 6,84 hours, the duration of the active phase of the first stage of labor in the acupressure massage group obtained an average of 5,34 hours. The results of the bivariate analysis showed that there was an average difference between oxytocin massage and acupressure massage on the duration of the active phase of the first stage of labor with a p-value of 0,000. Discussion: The conclusion of the study was that there was an average difference between oxytocin massage and acupressure massage on the duration of the active phase of the first stage of labor. Suggestions are expected for health workers, are expected to always be updated, especially in helping mothers give birth to meet the mother's need for comfort in non-pharmacological pain control, one of which is using acupressure or oxytocin massage techniques.

The Effect of a Non-Pharmacological Multicomponent Pain Management Program on Pain Intensity and Quality of Life in Community-Dwelling Elderly Men With Chronic Musculoskeletal Pain

Background and AimImproving the level of care for the elderly with musculoskeletal pain requires pharmacological and non-pharmacological pain control methods. This study aimed to investigate the effect of a non-pharmacological pain management intervention on pain intensity and quality of life in community-dwelling older men with musculoskeletal pain who were referred to comprehensive healthcare centers in the city of Ilam, Iran. Materials and MethodsA quasi-experimental study with pre and post-test design was performed on 65 older men with chronic musculoskeletal pain. The samples were selected regarding inclusion criteria as available and randomly assigned to either the control (usual care) or the experimental group (educational intervention plus physical exercises). Baseline characteristics of participants, the Visual Analogue Scale, and the CASP-19 Quality of Life were used to collect data. Data were analyzed by SPSS software using the ANCOVA, independent and paired t-test, and chi-square test at the statistically significant level of 5 %. ResultsAccording to the findings, there was a significant difference between the experimental and control groups in terms of quality of life (p < .05) and pain intensity (p < .05) after the intervention. No relevant differences were found between groups regarding demographic characteristics at baseline. ConclusionsA six-week physical activity and education program for community-dwelling older men with chronic musculoskeletal pain could improve quality of life and decrease pain intensity after a one-month follow-up compared with usual care. Therefore, it seems necessary to consider pain management programs in the elderly care program and familiarize health care professionals with these pain control methods.

Effect of Multimodal Integrative Interventions on Pain-Related Outcomes among Critically Ill Patients

Context: Pain, a persistent problem in critically ill patients, adversely affects outcomes. Despite recommendations, no evidence-based non-pharmacological approaches for pain treatment in critically ill patients have been found.&#x0D; Aim: To evaluate the effect of multimodal integrative interventions on pain-related outcomes among critically ill patients.&#x0D; Methods: A quasi-experimental design (pre / post-test) was utilized to fulfill the aim of this study. A convenience sample of sixty adult critically ill patients was recruited from the intensive care unit at Benha University Hospital, affiliated to Benha University at Qualyubia Governorate, Egypt. Three tools were used to conduct this study as follows: Critically ill patients' assessment record; The Critical-Care Pain Observation Tool (CCPOT); The Groningen Sleep Quality Scale.&#x0D; Results: The results show decreased frequency of pain occurs in the post-intervention periods (75%) immediately post to 50% after 48 hours of intervention compared with pre-intervention (100%). The results show highly statistically significant differences at p ≤0.001 between pre and post of intervention periods regarding the intensity of the pain mean score among studied patients. It also shows statistically significant differences with p-value ≤0.05 regarding all items of sleep quality immediately after and after 48 hours of intervention compared to pre-intervention, except those related to having a deep sleep last night and feeling like a slept poorly last night with a p-value ≥0.05. There was a highly positive statistically significant correlation at p-value ≤ 0.001 between pain intensity and other secondary outcomes, including quality of sleep, blood pressure, heart rate, and respiratory rate.&#x0D; Conclusion: Multimodal integrative interventions effectively decrease pain and improve pain-related outcomes among critically ill patients. Appropriate pain assessment must be partnered with an adequate, multimodal, evidence-based management strategy that incorporates pharmacologic and non-pharmacologic pain control modalities.

Effects of Cold Therapy on Pain and Anxiety During Needle Removal From Implanted Ports.

This study was conducted as a quasiexperimental, single-blind study to examine the effect of cold therapy on pain and anxiety during port needle removal. Patients in the experimental group received cold therapy 10 minutes before port needle removal. Patients in the control group received no intervention before port needle removal. Data were collected using the visual analog scale (VAS) and State-Trait Anxiety Inventory (STAI). After cold therapy was applied to the patients in the experimental group, the second and third VAS scores were found to be statistically significant and lower than those in the control group ( P < .05). There was no statistically significant difference between the anxiety levels of the experimental group and the control group before cold therapy ( P > .005). However, the STAI scores of the experimental group were found to be statistically and significantly lower than those of the control group after cold therapy ( P < .05). This study determined that cold therapy before port needle removal reduces pain and anxiety. Cold therapy may be recommended as an effective nonpharmacological pain control method with ease of application to prevent pain induced by port needle removal.

PENGARUH PIJAT OKSITOSIN TERHADAP LAMA PERSALINAN KALA I FASE AKTIF DI KLINIK PIM KOTA DEPOK TAHUN 2021

Background: The other causes of maternal deaths In West Java Province, 19.74%, one of which was due to prolonged labor. One way to speed up the progress of labor is by giving oxytocin massage. The purpose of the study was to knowing the effect of oxytocin massage on the duration of the active phase of the first stage of labor at the Ismail Medika Inpatient Pratama Clinic, Depok Period March-April 2021. Methods: quasi-experimental research design using a posttest only design with control groups. The sample in this study amounted to 30 mothers giving birth with each group consisting of 15 respondents with purposive sampling technique. The data were analyzed using the Mann-Whitney test which was previously tested for normality. Result: univariate analysis of the duration of labor in the first active phase of the intervention group was mostly normal 86.7%, the control group was mostly 66.7%. The results of the bivariate analysis showed that there was an effect of oxytocin massage on the duration of the first stage of labor in the active phase with a significance value of 0.000. The conclusion of this research is oxytocin massage affects the duration of the active phase of the first stage of labor. Suggestions for midwives are expected to be able to assist maternity mothers in meeting the mother's need for comfort in non-pharmacological pain control when providing delivery care by applying the oxytocin massage technique so that labor can run effectively and safely both in terms of the length of labor and the condition of the baby being born.

The Effect of the Smell of Breast Milk and Non-Nutritious Sucking on Pain Behavioral Response and to First-Time Hepatitis B Vaccine in Term Newborns

Background: The issue of Pain Management finds special significance in infants who are unable to verbally express pain. Studies have shown that the use of non-pharmacological pain control techniques can be effective in reducing neonatal pain. The aim of this study was to compare the effects of olfactory stimulation (with breast milk) and non-nutritive sucking (with a pacifier) on the physiological and behavioral responses in term neonates to the hepatitis B vaccine. Methods: In this clinical trial, which was done in 2015 at the Nohom-e Dey Hospital of Torbat Heidariyeh, 90 eligible infants were randomly selected and divided into two intervention and one control groups. In the breast-milk odor group (n = 30), the neonates were exposed to the mother's odor during vaccination. In the non-nutritive sucking group (n = 30), a standard soft pacifier was used, whereas, in the control group (n = 30), no intervention was carried out. Data collection tools included demographic information forms and the Neonatal Pain Response Scale. Data were edited and analyzed using SPSS 20 software. Results: This study showed that there was a statistically significant difference between the mean scores of neonatal behavioral responses after intervention in the three groups (p &lt;0.05). The mean behavioral response was 0.73 lower in the breast-milk odor group than in the control group, and the mean behavioral response in the non-nutritive sucking group was 0.6 lower than that of the control group. Conclusion: The results of the study showed that both olfactory stimulations with breast milk and non-nutritive sucking have a positive impact on neonatal pain reduction, nearly equally.

The effect of gentle human touch during endotracheal suctioning on procedural pain response in preterm infant admitted to neonatal intensive care units: a randomized controlled crossover study

Background Neonates in the neonatal intensive care unit are frequently subjected to painful procedures. Non-pharmacological pain control techniques are useful for reducing procedural pain. Touch as one of the aspects of developmental care used to reduce neonatal pain. The purpose of this study was to determine the effect of gentle human touch during endotracheal suctioning on procedural pain response in preterm neonates. Methods This was a clinical trial study with a crossover design. The study was conducted in a level III NICU in a hospital, affiliated to Iran University of Medical Sciences. Thirty-four neonates were enrolled in this study based on inclusion criteria. The samples were randomly received a sequence of suctioning with/without or suctioning without/with gentle human touch. Preterm Infant Pain Profile (PIPP) was used to collect the data. SPSS version 22 for Windows (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Results 85.3% of neonates experienced moderate and 8.8% severe pain during suctioning without intervention, and only 64.7% of them experienced moderate and 2.9% severe pain during suctioning with intervention. The results of the paired t-test show that there is a statistically significant difference between the mean scores of pain in nonintervention and intervention cases (p < .002), and the mean pain score substantially reduced in cases with intervention. Conclusions Results from this study showed that the pain due to suctioning procedure is considerably reduced by applying Gentle Human Touch. And nurses can use this method as one of the non-pharmacological methods of pain management.

The Reducing Opioid Use in Children with Clefts Protocol: A Multidisciplinary Quality Improvement Effort to Reduce Perioperative Opioid Use in Patients Undergoing Cleft Surgery.

Cleft repair requires multiple operations from infancy through adolescence, with repeated exposure to opioids and their associated risks. The authors implemented a quality improvement project to reduce perioperative opioid exposure in their cleft lip/palate population. After identifying key drivers of perioperative opioid administration, quality improvement interventions were developed to address these key drivers and reduce postoperative opioid administration from 0.30 mg/kg of morphine equivalents to 0.20 mg/kg of morphine equivalents. Data were retrospectively collected from January 1, 2015, until initiation of the quality improvement project (May 1, 2017), tracked over the 6-month quality improvement study period, and the subsequent 14 months. Metrics included morphine equivalents of opioids received during admission, administration of intraoperative nerve blocks, adherence to revised electronic medical record order sets, length of stay, and pain scores. The final sample included 624 patients. Before implementation (n =354), children received an average of 0.30 mg/kg of morphine equivalents postoperatively. After implementation (n = 270), children received an average of 0.14 mg/kg of morphine equivalents postoperatively (p < 0.001) without increased length of stay (28.3 versus 28.7 hours; p = 0.719) or pain at less than 6 hours (1.78 versus 1.74; p = 0.626) or more than 6 hours postoperatively (1.50 versus 1.49; p = 0.924). Perioperative opioid administration after cleft repair can be reduced in a relatively short period by identifying key drivers and addressing perioperative education, standardization of intraoperative pain control, and postoperative prioritization of nonopioid medications and nonpharmacologic pain control. The authors' quality improvement framework has promise for adaptation in future efforts to reduce opioid use in other surgical patient populations. Therapeutic, III.

Virtual Reality Analgesia With Interactive Eye Tracking During Brief Thermal Pain Stimuli: A Randomized Controlled Trial (Crossover Design).

In light of growing concerns about opioid analgesics, developing new non-pharmacologic pain control techniques has become a high priority. Adjunctive virtual reality can help reduce acute pain during painful medical procedures. However, for some especially painful medical procedures such as burn wound cleaning, clinical researchers recommend that more distracting versions of virtual reality are needed, to further amplify the potency of virtual reality analgesia. The current study with healthy volunteers explores for the first time whether interacting with virtual objects in Virtual Reality (VR) via “hands free” eye-tracking technology integrated into the VR helmet makes VR more effective/powerful than non-interactive/passive VR (no eye-tracking) for reducing pain during brief thermal pain stimuli.MethodForty eight healthy volunteers participated in the main study. Using a within-subject design, each participant received one brief thermal pain stimulus during interactive eye tracked virtual reality, and each participant received another thermal pain stimulus during non-interactive VR (treatment order randomized). After each pain stimulus, participants provided subjective 0–10 ratings of cognitive, sensory and affective components of pain, and rated the amount of fun they had during the pain stimulus.ResultsAs predicted, interactive eye tracking increased the analgesic effectiveness of immersive virtual reality. Compared to the passive non-interactive VR condition, during the interactive eye tracked VR condition, participants reported significant reductions in worst pain (p < 0.001) and pain unpleasantness (p < 0.001). Participants reported a significantly stronger illusion of presence (p < 0.001), and significantly more fun in VR (p < 0.001) during the interactive condition compared to during passive VR. In summary, as predicted by our primary hypothesis, in the current laboratory acute pain analog study with healthy volunteers, increasing the immersiveness of the VR system via interactive eye tracking significantly increased how effectively VR reduced worst pain during a brief thermal pain stimulus. Although attention was not directly measured, the pattern of pain ratings, presence ratings, and fun ratings are consistent with an attentional mechanism for how VR reduces pain. Whether the current results generalize to clinical patient populations is another important topic for future research. Additional research and development is recommended.

Immersive virtual reality as analgesia for women during hysterosalpingography: study protocol for a randomized controlled trial

BackgroundHysterosalpingography (HSG) is an accepted radiologic diagnostic modality for initial infertility workup, and is generally considered uncomfortable and painful. However, the management of pain related to HSG remains inefficient. As an emerging nonpharmacologic and noninvasive pain control strategy, virtual reality (VR) distraction has been successfully used in areas such as burns, blunt force trauma, hospital-based needle procedures, dental/periodontal procedures, and urological endoscopy patients. This study aims to evaluate the analgesic effect of VR during HSG.Methods/designA single-center, parallel-group, randomized controlled trial will be carried out in the Radiology Department of Yinchuan Women and Children Healthcare Hospital, Yinchuan. A total of 200 participants who are scheduled for HSG will be enrolled in this study. The participants will be randomized (1:1) into two groups: a VR group and a blank control group. The VR group will receive routine care plus immersive VR intervention and the blank control group will receive routine care. Outcomes will be monitored at baseline, immediately after HSG and 15 min after HSG for each group. The primary outcome is the worst pain score during HSG by a visual analog scale (VAS). The secondary outcomes include: affective pain, cognitive pain, and anxiety during the HSG procedure; worst pain within 15 min after HSG; patient satisfaction and acceptance with pain management; physiological parameters; adverse effects; HSG results; and immersion perception score of the VR system (for the VR condition only).DiscussionThis study will focus on exploring a simply operated, noninvasive and low-cost analgesia during the HSG procedure. The results of this trial will provide data on the feasibility and safety of VR distraction therapy during HSG.Trial registrationChinese Clinical Trial Register, ChiCTR1900021342. Registered on 16 February 2019.

The effect of sacral massage on labor pain and anxiety: A randomized controlled trial.

Nonpharmacologic pain control methods, which are increasingly becoming widespread in coping with labor pain, are the methods that allow women to completely relax without using any medication and direct them to perceive the pain at the lowest level. This study was conducted to determine the effect of sacral massage on labor pain and anxiety. This study was conducted as a randomized controlled experimental study at Bağcılar Hospital, Obstetrics and Gynecology Clinic between March and October 2016. In all, 60 women, 30 of whom were in the control group and 30 of whom were in the experimental group, constituted the research sample. The women in the experimental group were administered a massage to the sacral region for 30 min. The questionnaire form, birth action follow-up form, postpartum interview form, visual analog scale (VAS) and state-trait anxiety inventory were used to collect data in the study. The latent phase VAS averages (3.57 ± 1.43), active phase VAS averages (7.03 ± 1.5) and transition phase VAS averages (8.83 ± 1.78) of the experimental group were found to be statistically significantly lower than those of the control group (P < .05). It was concluded that sacral massage applied during labor reduced women's labor pain, lowered the levels of concern and anxiety, led to greater feelings of satisfaction among pregnant women in terms of labor, positively affected the perception of labor and had no fetal side effects.

C3 Non-pharmacological Acute Pain Control Utilizing Nurse-led Aromatherapy in Coronary Bypass Graft Patients: A Pilot Study

Coronary Artery Bypass Graft patients require adequate pain control post-operatively in order to effectively participate in cardiac rehabilitation. Complimentary non-pharmacological pain control is essential to limit known side-effects of narcotic agents. Methods of this project included a pre and post pain score evaluation using the pain Assessment Intervention Reassessment (AIR) cycle, a nursing sensitive indicator. A rating system of 1-10 was used before and after intervention. Intervention included distillation of essential oils through aerosol, massage, or application of diffuse cotton gauze to bed linens.

Effects of transcutaneous electrical nerve stimulation on pain after impacted third molar surgery.

BackgroundThe aim of this study was to assess the therapeutic effects of Transcutaneous Electrical Nerve Stimulation (TENS) on pain after the impacted third molar surgery.Material and MethodsThe study was carried out on 30 patients attending the outpatient department of the oral and maxillofacial surgery. Both sides’ impacted mandibular third molars were taken into consideration, and a total of 60 impacted third molars were undergone surgical extraction. After the first surgery, patients were given analgesic, antibiotics, and mouthwash as a routine treatment procedure. Following the second surgery, TENS was applied over the painful area of the cheek for patients in addition to routine treatment procedure. Pain was evaluated with Visual Analog Scale (VAS) at the postoperative 6, 8, 24 hours and 2,3,4 and 5 days. The Student t test was applied to compare pain levels between groups. P<0.05 and p<0.001 were considered significant in all statistical analyses.ResultsThe study was carried out in 30 patients 15 (50%) female and 15 (50%) male, aged between 20 and 31 years. The mean age of the patients was 24.60 ± 4.76. There was a statistically significant difference in the evaluation of VAS levels in postoperative 6, 8, 24 hours and 2, 3, 4, and 5 days between the routine treatment group and the TENS application group.ConclusionsTENS activates a complex neuronal network to result in a reduction in pain. In conclusion, TENS application was highly effective in pain modulation following the third molar surgery. Therefore, TENS, which is one of the non-pharmacological pain control methods after such surgeries, can be used safely in reducing postoperative pain. Key words:Impacted teeth, third molar, pain, transcutaneous electrical nerve stimulation.

Pain Management for First-Trimester Uterine Aspiration.

First-trimester uterine aspiration can easily be performed in the office setting if adequate pain management for the patient is achieved. It is important for clinicians to understand evidence-based approaches for pain control to ensure a safe and efficient procedure. This article reviews the literature regarding pharmacologic and nonpharmacologic pain control options for first-trimester abortion performed in the clinical setting. Preoperative, procedural, and postoperative pain control are all reviewed. Authors searched the online database PubMed for relevant published literature through January 2018. To identify possible publications for review, the key word "abortion" was paired with the following key words: "pain," "pain-control," "pain management," "aspiration," "paracervical block," "sedation, "non-pharmacologic," and "post-operative." Optimizing pain control for first-trimester uterine aspiration may involve interventions before, during, and after the surgery. Evidence shows patients benefit from premedication with nonsteroidal anti-inflammatory drugs, a defined paracervical block technique, and an option to use one of several nonpharmacologic interventions. Pain management for first-trimester uterine aspiration should be individualized for optimal patient satisfaction. Evidence supports multiple approaches to support this individualization. Targeted interventions before, during, and after the procedure should be offered to improve procedure experience and satisfaction.

Therapeutic suggestions with critically ill in palliative care.

Suggestions can be used without formal hypnosis, especially with critically ill patients, due to their spontaneous trance state. In this paper we outline data on the effectiveness of therapeutic suggestions. We interpret the possible mechanism of therapeutic suggestions in the context of stress cognition. Basic principles of formulating suggestions are discussed and some recommended versions of non-pharmacological pain control are provided. Case vignettes are given of how suggestions are used with critically ill ICU patients.

EFFECT OF EFFLEURAGE TECHNIQUES TO INTENSITY PAIN ON DELIVERING BABY AT 1st PERIOD ACTIVE PHASE Of MOTHERS DELIVERING BABY IN BPM Hj.NINIK ARTINGSIH.,SST.M.Kes BLOOTO DISTRICT MOJOKERTO

The pain on delivering baby was experienced by most women, this pain is unique and different for every individual. Non-pharmacological pain control becomes cheaper, simple, and effective and without adverse effects, one of which is the technique effleurage. Effleurage of the abdomen is one of the non-pharmacological methods which are usually used in the Lamaze method to reduce pain in normal labor. This research aimed to determine the effect of effleurage technique on active phase of the first stage of labor pain intensity on maternal in private midwife Hj.Ninik Artiningsih.,SST.M.Kes Blooto District Mojokerto Regency. Research design was pre experimental type one group pre-test post test design. Its population were all women giving birth in BPM Hj.Ninik Artiningsih.,SST.M.Kes, SST Blooto distric Mojokerto Regency amount 17 people. The sampling technique used consecutive sampling to obtain 15 samples. Data analysis used was Wilcoxon test with P value &lt;0.05. It means that there was effect of effleurage technique on active phase of the first stage of labor pain intensity on maternal in private midwife Hj.Ninik Artiningsih.,SST.M.Kes Blooto District Mojokerto Regency. Gently cares the abdomen effected in pain that transmitted will be inhibited, it effected in the cerebral cortex does not receive the response message so that the pain decreased pain