European Journal of Molecular & Clinical Medicine

LMWH has been a promising drug because of its predictable anticoagulant response in the treatment and prophylaxis of thromboembolic phenomena. Among its local complication, the reported incidence rates of bruises is 26.6% to 88.9% and pain is 93.7-98.7%. Nurses limit the areas that can be injected by avoiding repeated injections in the bruised area.  The primary goal of the study was to determine how cold application affected ICU patients pain and bruises caused by subcutaneous injection of low molecular weight heparinat specific hospitals' in Navi Mumbai. A quasi-experimental post-test-only design with Non Probability sampling technique was used to select 50 samples with split body image.  Cold application utilizing frozen gel packs was used  for 3 minutes before and 5 minutes after the subcutaneous  injection of LMWH. The pain was assessed using numerical pain rating scale and  the bruise was assessed by using bruise assessment scale. The respondents of the experimental side had a mean pain score of 2.80±0.81. The respondents of the control side  had a mean pain score of 4.62±0.85. The results of the Wilcoxon test showed that the pain intensity of the experimental side was significantly lower compared to the control side(P < 0.05)at 48 and 72 hours; the  respondents of the experimental side had a mean bruise score of 0.20±0.61 and the  respondents of control side  had a mean bruise score of 1.56±0.84. Friedman's test shows that at 78.00 and 10.00 in the control and the experimental side, the level of significance at 5% level is 0.000 and 0.007 respectively. In clinical practice, a cold application utilizing frozen gel packs for 3 minutes before and 5 minutes after the injection of LMWH is effective. 

Endodontic emergencies usually result from inflammatory reactions in pulpal or periapical tissues. They constitute a major part of all dental emergencies ^1,2 and require immediate diagnosis and treatment. In general, emergencies are unscheduled visits by patients in severe pain, under emotional distress and seeking immediate relief. Although the endodontic emergency is disruptive and often inconvenient, proper management is satisfying to the dentist and much appreciated by the patient; improper treatment is frustrating and stressful.

Background & Aim of the work: Vaccination is a public health measure used to fight infectious diseases. One of the most frequent and painful procedures performed on children is receiving a vaccine injection, especially when no pain medication is used. The researcher employed cartoon video as a distraction method in the current investigation. The study aims to discover whether cartoon videos could benefit toddlers (1 to 3 years old) in reducing their behavioral response to vaccination pain, who visit the pediatric outpatient department inselected hospitals in Navi Mumbai.
Materials and Methods: Purposive sampling was used to collect data using a quasi-experimental post-test group design. The study's 82 samples, of both sexes and between the ages of 1-3 years, were divided into experimental (41 samples) and control (41 samples).A randomized number generator was used to avoid bias in selecting the sample groups. The demographic interview questions and the FLACC Revised scale were employed as the study's instruments for assessing and observing the toddler's behavioral response to the process. Descriptive (frequency, percentage distribution) and inferential statistics were used in the data analysis (X2 and Mann-Whitney U test). 
Results: The study's findings showed that while comparing the pain score among the groups, the experimental group experienced a pain score of 6.12 ± 1.926, while the control group experienced a pain score of 8.00 ± 1.466, with a difference of 1.88. The intergroup comparison of pain among the experimental and control group showed a Mann-Whitney U test value of 0.000**, which strongly showed a statistically highly significant difference between the two groups (p<0.01) with higher values in the control group as compared to the experimental group. An analysis of the relationship between pain intensity and demographic factors revealed a statistically significant relationship between children's prior experiences and their attitudes toward medical professionals. Hence the study has proven that cartoon video distraction is an effective distraction technique.

 Background: In critically ill patients, Pain is a major problem; efficient pain management depends on a systematic, comprehensive assessment of pain. Hemodynamic parameters change with simple non-invasive procedures. Monitoring of the change will help in determining the better systematic way to carry out the procedures for quality care.
 Aim: The study aimed to review and synthesize current evidence on the impact of a systematic approach to pain assessment and hemodynamic monitoring on critically ill patient outcomes.
 Methods: A comprehensive search for primary research articles was conducted using the Medline and PubMed, Eric, Cochrane and google scholar databases, using the keywords ‘assessment of pain in mechanically ventilated patient’, ‘changes in hemodynamic parameter during nursing procedures’, ‘impact of nursing procedures on mechanically ventilated patients’ were entered into a search engine. A number of highly pertinent papers relevant to the aims of the review were identified, only those papers, which satisfied the inclusion criteria, were selected for inclusion in this review.
 Discussion: In the study all the reviews were able to produce significant results with regard to pain and hemodynamic parameters. Assessment of pain behaviours’ was common, these assessments were observed and documented with the use of is widely accepted that the use of reliable behavioural pain assessment tool can assist health care providers in early identification of pain in critical ill patients and subsequently in the prompt of efficient management of pain. An assessment tool for hemodynamic parameters was not developed in the above studies which might help the nurses to identify the patient’s discomfort.
 Conclusion: The nursing procedures such as suctioning, positioning, oral care   and changing of the dressing did bring change in hemodynamic parameters and as well induced pain to the patient. The procedures cannot be withheld instead it can be deliberately planned so as to provide comfort and quality care to the patient.

Maximum bite force is a useful indicator of the functional state of the masticatory system and the loading of the teeth, and its recordings can be performed in a relatively simple way in the clinic. Previous studies have found a change in bite force due to orthodontic treatment, before and after treatment. This article reviews bite force, its measurement and changes by orthodontic treatment by fixed appliances.

Since pain has been reported to occur in 25%–40% of patients treated for endodontics procedure, it is a major concern for dentists and their patients. Hence in dentistry, nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed to treat pain and swelling. The most frequently used of these medications are ibuprofen and paracetamol. They work by inhibiting the enzyme cyclooxygenase, which then prevents the production of prostaglandins. All of these medications exhibit a comparable mode of action, which causes them to have comparable side effects. The present article reviews the knowledge currently available on NSAIDs with a focus on dental practice-related elements

Objective: Study investigated Effectiveness of Cryotherapy on Pain relief during intra venous Cannulation among Adult Patients. Method: Post test only control group design was used to conduct the study among adult patients and totally 40 patients were allotted 20 each in the experimental and control groups by Purposive Sampling technique. Ethical permission was obtained before the data collection. After obtaining permission from the setting, the patients were asked their willingness to participate in the study and informed consent was obtained. The experimental group receives Cryotherapy and control group was not receives Cryotherapy during intra venous Cannulation. The pail level was assessed by using numerical pain scale in both groups. The collected data were studied and analyzed in terms of objectives of the study using descriptive and inferential statistics.

Scalp injections and microneedling both are treatment methods that cause pain and discomfort during the procedure and the majority of patients require or demand a form of anesthesia to ease the discomfort. Non-invasive methods for pain reduction during dermatological procedures include topical anesthetic drugs, skin cooling, and vibration. Skin cooling can lower the skin temperature during procedures, and thereby improve pain and discomfort (cryoanalgesia).
Method: Patient is asked to wear a frozen hypothermic gel helmet or Cryo-cap cooled in the refrigerator for 20-30 minutes before the procedure.  Then we remove the cap and start immediately the injections .
Results:Subjective improvement in pain threshold and good patient tolerance during scalp microneedling which allowed us to perform faster during the treatment sessions.
 simple, effective and it helps to avoid local anesthesia risks as well as its discomfort, and allows faster performance.
Conclusion:Cryo-caps or hypothermic gel helmets are simple yet effective technique to avoid local anesthesia risks as well as its discomfort, and allows faster performance

Introduction: It has been reported around 1.2 billion peripheral intravenous catheters are inserted in hospitalized patients across the world annually and nearly four out of five patients admitted to the hospital receive a peripheral intravenous catheters, which makes peripheral intravenous catheters insertion one of the most regularly practiced invasive procedures by both medical and nursing staff. Objective: study investigates thatPain during intravenous Cannulation among Adult Patients admitted at tertiary care hospital. Method: Pretest only design was used to conduct the study among adult patients and totally 20 patients were allotted by Purposive Sampling technique. Ethical permission was obtained before the data collection. After obtaining permission from the setting, the patients were asked their willingness to participate in the study and informed consent was obtained. The pain level was assessed by using numerical pain scale. The collected data were studied and analyzed in terms of objectives of the study using descriptive and inferential statistics.

Background: Dentists in their practice are exposed to work-related vibrations on a daily basis. Carpel tunnel syndrome occurs due to overuse of the hand while using vibratory equipment such as sizing, turbines, and handles with slow speeds, gripping and working with tools or other small objects such as endodontic files.
Objectives: The main aim of this cross-sectional study was to measure the prevalence of carpal tunnel syndrome among dental students and dental assistants
Methodology: A questionnaire was utilized in this study to determine the prevalence of CTS. The prevalence was measured using the Symptom Severity Scale. We got 209 responses from dental colleges in Saudi Arabia.
Results: More than 100 participants indicated that they had symptoms of carpal tunnel syndrome. The patient with symptoms generally complained of little hand pain at night. They are often encountered with mild to severe hand pain during the day. It was determined whether the hand numbness was slight, moderate, or severe. The individuals mainly described slight hand numbness.
Conclusion: Carpal tunnel syndrome is a prevalent condition, and dental assistants and students in our investigation were more likely to develop it than the general population. To prevent severity since students are more likely to be affected, it would be advantageous if good ergonomics were used and taught to students at the academic level.

The use of medicinal plants in treatment has been very common nowdays. Colocynth, Scientifically kwon as Citrullus colocynthis is used to reduce pain and inflammation in traditional medicine. C. colocynthis are already reported as rich source of different phytochemical constituents and responsible for many pharmacological applications. The aim of present study is to evaluate the effects of acetone extract of Colocynth fruit (AECC) on pain and inflammatory mediators at doses of 100 mg/kg, 200mg/kg, 400mg/kg by using tail flick and formaline induced pain methods. Our observations indicated that C. colocynthis fruit acetone extract can reduce pain and inflammation and we can use this plant as analgesic and anti inflammatory agent in the future.

Background: Post surgery is a painful experience for everyone, children are more vulnerable to stress and it is important to manage anxiety and pain after surgery. Aim: The aim of this study was to determine the effect of a play intervention in reducing anxiety and pain levels among post-operative hospitalized children admitted in a selected hospital. Methods: A randomized controlled Trial, 126 participants were recruited from paediatric surgery ward. Ages between 6-12 years, play activities were performed 63 children in intervention group provided play therapy and 63 in control group obtained the daily routine care without any play intervention. Children who received play intervention were less negative and had lower levels of anxiety and pain than children who received normal daily routine care.

Coccydynia is a common condition that is often self-limited and mild. Although the vast majority of patients who seek medical attention respond to conservative treatments, some patients require more aggressive treatments. In these cases, the etiology of the coccydynia may be complex and multifactorial. A multidisciplinary approach employing physical therapy, ergonomic adaptations, medications (NSAIDs), injections, and, possibly, psychotherapy leads to the greatest chance of success in these patients. Surgical coccygectomy generally is not recommended, and although different surgical techniques are emerging, more research is needed before their efficacy can be established.

Introduction: Swelling in the epigastrium is caused by those organs anatomically present in the region as well as by other organs in the other regions. This study was done with an interest to know the clinical presentation of the various cause of the epigastric swelling.
Methods: Fifty-two cases with a pathological swelling in the epigastrium, who were admitted to tertiary care center, were randomly selected those cases were studied during their stay in the hospital. In this study, the swelling from stomach and pancreas were included aged more than 12 years and the rest excluded. Relevant investigations were made and the diagnosis confirmed.
Results: There were 16 cases of pancreatic swellings and 11 cases of stomach swellings. Carcinoma stomach and pseudocyst each 21%, secondaries 17%, carcinoma pancreas 9.6%. Symptoms were Nausea (61.53%), pain (55.76%), vomiting (51.95%), weight loss (40.38%), fever (34.61%), anorexia (32.69%).
Conclusion: In this study, the most common swelling was the carcinoma stomach and pseudocyst of pancreas. Most common symptom was nausea, followed by pain, weight loss. The least common symptom was gastrointestinal bleeding

Background: Laparoscopic cholecystectomy (LC) has become the gold standard for treatment of benign Gall Bladder disease. Pain after laparoscopic surgery though primarily visceral, often affecting the sub diaphragmatic region and often referred to the right shoulder region, also has a parietal component which occurs at the trocar site. The present study was planned to evaluate the effect of combined port site levobupivacaine administration before and after surgery for patients who underwent Laparoscopic cholecystectomy.
Material & Methods: This was a hospital based prospective randomized double blind comparative study done on 100 patients undergoing elective laparoscopic cholecystectomy surgery at Jawahar Lal Nehru Hospital, Ajmer, after approval from ethical committee. The study population were randomly divided into two groups A (Preincisional) and B (Post incisional) with 50 patients in each group using computer generated tables of random numbers. The primary outcome variable was to compare pain (visual analogue scale [VAS]) score. The intensity of post-operative pain was recorded for all the patients using VAS score at 3, 6, 12, 24 h after surgery (mean of all VAS scores).
Results: Our study showed that mean age of patients in group A was 43.20 years and 41.16 years in group B, which was statistical non-significant (P=0.435). There was significant difference in the mean VAS scores between the two groups up to 12^th hour postoperatively. There was statistically lower VAS score in group A as compared to group B postoperatively up to 12 hour at 24^th postoperative hour there was no significant difference in VAS score in both groups. The mean duration of analgesia was 164.94 ± 27.37 min in group A with a range of 95 to 210 min., while in group B, the mean duration of analgesia was 121.42 ± 14.81 min. with a range of 85 to 145 min, which was statistically longer in Group A as compared to Group B, (p value < 0.0001). Mean number of doses required in group A was 1.70 ± 0.46 and in group B was 2.38 ± 0.49, which was statistically higher in group B (p value <0.0001). In group A total amount of tramadol required in 24 hours was 170.00 ± 46.29 mg in comparison to group B where it was 238.00 ± 49.03 mg (p value <0.0001).
Conclusion: We concluded thatlevobupivacaine can be safely used as local anesthetic infiltration for postoperative pain relief following laparoscopic cholecystectomy surgery.

Background: It was well reported that gabapentin has a role in the management of neuropathic pain. However, substantial evidence for the same was sparse.
Objective: The present study was undertaken to evaluate the effectiveness of gabapentin in the management of postoperative pain after total hip arthroplasty.
Materials and methods: A total of 50 patients diagnosed with sepsis and aged more than 18 years including both males and females were part of the study after obtaining the written, voluntary informed consent. Unwilling participants were excluded from the study. Patients with any severe complications were also excluded from the study.
Results: The majority of the participants were males with 60 % and females were 40%. The majority of patients were having pain scores of 7-9 before the intervention in the control group. The majority of the patients are in pain scores of 7-9 after ibuprofen in the control group. Table no 5 presents the distribution of the intervention group participants according to the pain scores after intervention. The majority of the patients were in pain scores of 1-3 after the administration of gabapentin.
Conclusion: The study results confirm that gabapentin has a significant effect on the management of pain after the surgery of the knee and hip. The study recommends further detailed study in this area to recommend gabapentin in the management of pain.

The objective of this study was to identify the effectiveness of dry cupping and hot pack on pain relief and reduce functional disability for patients with non-specific low back pain. A total of 39 patients with non-specific low back pain from Sultan Idris Education University, Malaysia who fulfilled the inclusion criteria were chosen as participants using purposive sampling methods. The participants were randomly assigned equally (N=13) into dry cupping group, hot pack group and control group. Dry cupping group received a session of treatment in a week, hot pack group received twice a week of treatment session and control group had no treatment, but the participants were allowed to continue their previous treatment. Numerical Pain Rating Scale (NPRS) was used to measure pain intensity and Oswestry Disability Index (ODI) was used to measure functional disability before and after the intervention for all three groups. Data was analyzed using one-way ANOVA with significant level was predetermined at p<0.025 prior to study. The study findings indicated that both dry cupping group and hot pack group showed significant improvement on pain relief (p=0.001) and functional disability (p=0.001) after completing the interventions when compared to control group. Therefore, both dry cupping and hot pack were found to be effective interventions for pain relief and reduce functional disability among patients with non-specific low back pain. Health professional practice are suggested to include dry cupping therapy as another choice of treatment in treating patients with non-specific low back pain.

A growing number of publications in the literature show that chronic pain is
also characteristic of patients with terminal renal failure (TRF). The disease tends to be
moderate or severe and affects virtually all aspects of health and quality of life.
Unfortunately, there is a lack of clinical and research focus in nephrology, and TAPN pain
is poorly understood. The article reflects the main aspects of the problem of pain
medication therapy for patients with terminal renal insufficiency receiving chronic
hemodialysis. The main pathophysiological mechanisms of medication influence on kidney
structures are described.

Temporomandibular disorders are considered as the main source of pain in the head and neck region which is of non- dental in origin. Its etiology is multifactorial and its pathogenesis has not been completely understood. The interest in the relationship between occlusal factors, orthodontic treatment and TMD has increased over the years. Hence the aim of this article is to review ten association of TMD and orthodontics from the available literature.

REBA and RULA Ergonomic tools are used for evaluation and ergonomic assessment while carrying, handling, lifting and shifting the load. For evaluation of complex manual water fetching activities a RULA and REBA ergonomic tool is used .In this study of water fetching activities maximum women from rural area were participated. Based on this ergonomic tool observation, water fetching activities of women while water fetching, video recordings and photographs were taken. The reviewed literature, postural activity guidelines are proposed for summarizing analysis of water fetching women’s activity and discomfort has been reported. The basic aim of water fetching study is to make assessment of the level of exposure of ergonomics in various water fetching activities. Another objective of the water fetching activities is to find the level of exposure and musculoskeletal disorders in different body segment and gives the corrective steps to reduce the health risk in the water fetching activity.

Oral health is a vital part of overall infant health.An early age between 6 months to 12 months dental visit is important in rendering prevention,intervention and parental counselling regarding oral health. Pain is an unpleasant sensory and emotional experience associated with actual potential tissue damage according to internal association for the study of pain. Aim of the study is to assess the association between age of the first dental visit and pain in children. A retrospective cross-sectional study was conducted using the patient records from the Department of pedodontic, Saveetha Dental College,visited from February 2019 to February 2020.The children with first dental visit without the past dental history were collected and from which whosoever first visit with chief complaint of pain data were gathered . The collected Data was then subjected to statistical analysis using spss version 20.0.Overall prevalence of chief complaint of pain during first visit was (96.5%). Among first dental visit with pain about 47.2 % was seen in the age of 6-8 years while the least was (14.0%) seen at the age of 11-13 years.The results proved that many parents were unaware about the right age of the child first dental visit.Most of the parents bought their children to the dentist after their child experienced or suffered from pain.There is a need to raise awareness about the importance of oral health care of their children sensitively at the budding stage of life

Background: Migraine pain is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Objective: To evaluate the effect of noninvasive pulsed radio frequency (pulsed RF) in Migraine. Methods: In a prospective study of the intervention performed in adult population with Migraine (Diagnosed by specialists) carried on (30) patients undergone pulsed RF for greater and lesser occipital nerves to control recurrent migraine not responding to conventional treatment (resistant) in a period from Jan. 2017 to Jan 2019 in Al Safeer Hospital for surgical specialties and Alkafeel Hospital for surgical specialties both in Karbala / Iraq. The patients got in prone position under local anesthesia with goal positions with the target sites obvious out using anatomical breakthroughs and the position of greatest ache. Pulsed RF by RF needle to the affected side to reach greater and lesser occipital nerves then got 3 sessions (each for 3 minutes, temperature 42 C, voltage 42 V, resistance with 100 Ohms, Current with 230 mA) Patients monitored post-operatively for 2 hours then discharged. Follow up at intervals of 30 days, 6 months and 1 year by phone call or direct interview to assess the post procedure pain scale. Result: Significant pain relieve by means of no or little pain medication and actual life pattern change and performance in 1-year post procedure. Conclusion: A single trial of pulsed RF is effective for pain reliever.

Wet cupping is a traditional and alternative treatment that is still used to reduce patients’ pain in several Eastern and European countries. It has been proven effective and has an essential role in reducing pain and as a treatment for many diseases in past studies. Nowadays, there is a growing interest in the field of complementary and alternative medicine (CAM). This discipline includes a diverse set of approaches used for prevention and treatment of many diseases. Several benefits of CAM have been proven, and it may be considered an effective modality for disease prevention, treatment of non-communicable diseases and for improving the quality of life of individuals with chronic medical conditions.2 Many patients who may not be satisfied with the outcomes of modern medicine, particularly those with chronic diseases, may be satisfied with the outcomes of CAM. Pain is the most common reason for seeking therapeutic alternatives of conventional medicine. Cupping, wet or dry, is an ancient treatment, which was broadly utilized in several communities, and it was recommended by the Islamic society.
Aim of the study: The study aimed to assess the effect of wet cupping use among patients complaining of pain attended in the Hijama clinic in Makkah City at Saudi Arabia.
Method: A retrospective records review study was conducted using medical records of patients who attended in the Hijama clinic at Makkah, KSA from January 2019 to December 2019. Our total, 200 patients attended the clinic during the year 2019. Out of those patients, 120 were complaining of pain and were included in the study. The Chi-square test and Multivariate logistic regression were used to measure the association between the various socio-determinants and the wet cupping use.
 Results: A chi-square test of independence was performed to determine the association between the frequency of WCT use and the main complaint, independence was performed to determine the association between the frequency of WCT use and the main complaint. There was a statistically significant association between them, Chi-square X² =86.663, p=0.001.
 Conclusion: Wet cupping has positive effects on reducing pain. There are promising effects in favor of using wet cupping for improving quality of life of patients with chronic conditions, cupping is recommended as a complementary treatment modality for chronic medical conditions, especially pain .