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      Evaluation of the effects of ice massage applied to large intestine 4 (hegu) on postpartum pain during the active phase of labor

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          Abstract

          Background:

          The uterus continues to contract after childbirth. The pain caused by the contractions of the uterus can be as severe as labor pain. The study was aimed to evaluate the effects of ice massage applied to the large intestine 4 (LI 4) on postpartum pain during the active phase of labor.

          Materials and Methods:

          The study was designed as a randomized controlled trial with three groups and carried out in two stages. The study sample comprised of 150 pregnant women, who were referred to a maternity hospital. In the experimental group, ice massage was applied to LI 4 during four contractions within the active phase of labor. In the placebo group, pressure was applied to LI 4 using silicone balloons and the third group was the control group. The Visual Analog Scale (VAS) and The McGill (Melzack) Pain Questionnaire (MPQ) were compared among the experimental, placebo, and control groups.

          Results:

          The mothers in the ice application group had the lowest mean VAS score. It was determined that ice massage applied to LI 4 during the active phase of labor did not lead to any statistical differences in mothers in the first 24 hours postpartum in terms of the characteristics of the pain with MPQ and VAS.

          Conclusions:

          In the study, the perception of pain was tried to be minimized by applying pressure with ice balloons to LI 4. However, although the application was determined to have made no difference in the pain intensity, the mothers’ statements in the ice application group suggested that they felt more comfortable than did the mothers in the other groups.

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          Most cited references56

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          Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression.

          Cesarean delivery rates continue to increase, and surgery is associated with chronic pain, often co-existing with depression. Also, acute pain in the days after surgery is a strong predictor of chronic pain. Here we tested if mode of delivery or acute pain played a role in persistent pain and depression after childbirth. In this multicenter, prospective, longitudinal cohort study, 1288 women hospitalized for cesarean or vaginal delivery were enrolled. Data were obtained from patient interviews and medical record review within 36 h postpartum, then via telephone interviews 8 weeks later to assess persistent pain and postpartum depressive symptoms. The impact of delivery mode on acute postpartum pain, persistent pain and depressive symptoms and their interrelationships was assessed using regression analysis with propensity adjustment. The prevalence of severe acute pain within 36 h postpartum was 10.9%, while persistent pain and depression at 8 weeks postpartum were 9.8% and 11.2%, respectively. Severity of acute postpartum pain, but not mode of delivery, was independently related to the risk of persistent postpartum pain and depression. Women with severe acute postpartum pain had a 2.5-fold increased risk of persistent pain and a 3.0-fold increased risk of postpartum depression compared to those with mild postpartum pain. In summary, cesarean delivery does not increase the risk of persistent pain and postpartum depression. In contrast, the severity of the acute pain response to childbirth predicts persistent morbidity, suggesting the need to more carefully address pain treatment in the days following childbirth.
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            Update on nonpharmacologic approaches to relieve labor pain and prevent suffering.

            The control of labor pain and prevention of suffering are major concerns of clinicians and their clients. Nonpharmacologic approaches toward these goals are consistent with midwifery management and the choices of many women. We undertook a literature search of scientific articles cataloged in CINAHL, PUBMED, the Cochrane Library, and AMED databases relating to the effectiveness of 13 non-pharmacologic methods used to relieve pain and reduce suffering in labor. Suffering, which is different from pain, is not an outcome that is usually measured after childbirth. We assumed that suffering is unlikely if indicators of satisfaction were positive after childbirth. Adequate evidence of benefit in reducing pain exists for continuous labor support, baths, intradermal water blocks, and maternal movement and positioning. Acupuncture, massage, transcutaneous electrical nerve stimulation, and hypnosis are promising, but they require further study. The effectiveness of childbirth education, relaxation and breathing, heat and cold, acupressure, hypnosis, aromatherapy, music, and audioanalgesia are either inadequately studied or findings are too variable to draw conclusions on effectiveness. All the methods studied had evidence of widespread satisfaction among a majority of users.
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              The McGill pain questionnaire: from description to measurement.

              R Melzack (2005)
              On the language of pain. By Ronald Melzack, Warren S. Torgerson. Anesthesiology 1971; 34:50-9. Reprinted with permission. The purpose of this study was to develop new approaches to the problem of describing and measuring pain in human subjects. Words used to describe pain were brought together and categorized, and an attempt was made to scale them on a common intensity dimension. The data show that: 1) there are many words in the English language to describe the varieties of pain experience; 2) there is a high level of agreement that the words fall into classes and subclasses that represent particular dimensions or properties of pain experience; 3) substantial portions of the words have approximately the same relative positions on a common intensity scale for people who have widely divergent backgrounds. The word lists provide a basis for a questionnaire to study the effects of anesthetic and analgesic agents on the experience of pain.
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                Author and article information

                Journal
                Iran J Nurs Midwifery Res
                Iran J Nurs Midwifery Res
                IJNMR
                Iranian Journal of Nursing and Midwifery Research
                Medknow Publications & Media Pvt Ltd (India )
                1735-9066
                2228-5504
                Jan-Feb 2015
                : 20
                : 1
                : 129-138
                Affiliations
                [1 ]Department of Midwifery, Ege University Izmir Ataturk School of Health, Izmir, Turkey
                [2 ]Ege University Faculty of Nursing, Izmir, Turkey
                Author notes
                Address for correspondence: Dr. Hafize Ozturk Can, Department of Midwifery, Ege University Izmir Atatürk School of Health, Bornova/Izmir, Turkey. E-mail: hafizeztrk@ 123456gmail.com
                Article
                IJNMR-20-129
                4325405
                25709702
                0e941f9d-0473-4bc9-abc7-1d45817976a7
                Copyright: © Iranian Journal of Nursing and Midwifery Research

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 December 2013
                : 30 August 2014
                Categories
                Original Article

                Nursing
                hegu,ice massage,large intestine meridian point 4,postpartum pain
                Nursing
                hegu, ice massage, large intestine meridian point 4, postpartum pain

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