Tuesday, July 30, 2013
Sunday, July 28, 2013
what is pain ?
what is pain?
INTRODUCTION
Pain is a problem that must be faced by the health team; it is a symptom that can have acute or chronic characteristics and may worsen health state if it is not adequately relieved. However, as it is a complex and subjective phenomena, one may say that individuals in pain must be treated respecting their totality and individuality.
We recognize the importance of assessing pain, its management, and control, the American Society of Pain established this symptom as the "fifth vital sign", emphasizing that pain assessment is as important as the assessment of the other four vital signs and that health professionals need to record this phenomena. Thus, it is necessary to use scales to produce measure parameters and, consequently, an adequate pain control.
Studies on painful phenomenon are increasingly focusing on the complexity of their dimensions. Approaching other aspects rather than the sensitive ones makes it easier to understand this phenomenon. Broad and comprehensive understanding of the painful perception is important because it deals with other aspects besides pain intensity, such as the affective and motivational aspects of pain and the assessment of it.
The purpose of measuring is to assign value to a feature, trait, or state. In the case of pain measurement, the purpose is to give value to the pain experienced and/or perceived. Psychophysics is an experimental branch of Psychology that deals with measuring and assessing mechanisms and processes entailed in different sensitive and perceptive modalities(1).
The values of the exponent supply information on the basic properties of the "inflow-outflow" of the sensory and the perception dimension being studied; this features the rate at which an "outflow" system, indexed by the sensation, grows because of the "inflow" of the stimulus. The power function advocates that the principle of invariance between stimulus and sensation ratio, can be applied to all sensory systems, and is essential to survival of the body, that is, the sensory transducer works as a expander of the encouraging energy when necessary(2).
Magnitude estimation is based on the judgment of individuals to several stimuli, and it is one of the methods used to produce a ratio scale. The idea is to match perceived intensity of a physical stimulus with another perception. It is defined as the process to assign numbers proportional to social or clinical stimulus that reflect the intensity of the subjective answer. This method has important features as a measure strategy for subjective concepts such as pain(3).
When magnitude scales are designed, they should undergo psychophysics validation processes with the use of cross-modality matching which is specifically developed to check exponents obtained by ratio or magnitude estimation, according to the types of response used.
The paradigm of cross-modality matching supplies a method to confirm the power law, which checks the featured exponent and relates the magnitude of stimulus with the magnitude of subjective answer. Thus, instead of having subjects combining numbers to stimulus intensities, they use line lengths (tape measure) as a type of response. Thus, to rate a pain intensity scale, each subject may be guided to point out the size of tape measure that corresponds to the intensity of pain, the greater the pain, the greater the length of the line(4).
Psychophysics assess sensory, desirable, and cognitive components of pain, thus, it is very important to enhance its assessment, especially because it supplies ways to measure pain perception in its several dimensions(5).
The problem to assess and measure pain becomes psychophysical ant it involves detection, discrimination, and magnitude of the answer to the painful stimulus, thus, psychophysics presents the central assumption that the perception system is a measuring mechanism(6).
Measuring pain has been considered as a main challenge for those that want to control it adequately, since pain is understood as a complex, individual, and subjective perceived experience, that may be quantified only indirectly. Ever since pain has been studied in different ways in the investigation with animals, human beings, in laboratories or in clinical situations, integration of the knowledge from these domains has increased.
The search for understanding how the painful phenomena occur, how it is perceived by those experiencing it, and by those treating it results from the main goal professionals from the field have, which is to try to adjust treatment according to the source of pain, with no personal interferences in this process.
OBJECTIVES
General objectives
- To rank the different types of pain present, comparing them using different psychophysical methods;
- To validate the ratio scale derived to the nonmetric continuum of intensity of the different types of pain using cross-modality matching.
Specific Objectives
- to assess if the rank of the different types of pain derived from the two psychophysical methods are similar;
- to check stability and/or equivalence of the ratio scale, using two different answer modalities, numerical (magnitude estimates) and visual (line length).
MEASURING PAIN
Experiment - Validation of the ratio scale of the different types of pain using magnitude estimation method and cross-modality matching with the answer using line lengths
This study has been approved by the Ethical Committee of the Hospital das Clínicas of the Medical School of Ribeirão Preto, University of São Paulo. All participants gave their written consent, signing the term approved by this committee after they were verbally explained about the research, its objectives and accepted to take part.
This is an experimental quantitative study using Psychophysics as the paradigm and theoretical reference(2-4).
Methods
Participants: Thirty outpatients from different clinical specialties took part in the study; they were over 18 and were chosen from a convenience sample that could present any of the types of pain studied. Sixty health professionals, 30 physicians and 30 nurses also chosen from a convenience sample, specialized in different areas. The place of study was the Hospital das Clínicas of the Medical School of Ribeirão Preto.
Material: Pens and notepads, on the first page there were specific instructions for each psychophysical method and, in the following pages, a list with 20 different types of pain and their respective definition. Additionally, a professional tape measure with 5 meters in length was used.
Procedure: Psychophysics methods used were magnitude estimation method and cross-modality matching involving the answer continuum of the line length.
The instrument for data collection was built using the different types of pain: Low back pain, Head ache, Joint pain, Burn pain, Peripheral Neuropathy, Pain due to repeated strain injuries, AIDS pain, Postoperative pain, Cancer pain, Labor pain, Pain due to Temporomandibular Joint Disorder (TMJ), Pain due to Herpes-Zoster, Trigeminal neuralgia, fibromyalgia, Myocardial Infarction Pain, Renal colic pain, Pain from Gastric Ulcer, biliary colic pain, Menstrual Cramps pain, and Toothache. For each method used, different instructions were made.
Instructions given to subjects, regardless of the continuum of answer employed, demanded that judgments were performed according to intensity given to one type of pain.
In the method of magnitude estimation, the task of participants was to give a number for each type of pain that was proportional to pain intensity of that type and compare it with Standard stimulus that was low back pain with numerical value of 100. For example, if participants considered that a certain type of pain was two time more intense than low back pain, they should give to it a number twice as big, that is, 200. If participants considered that a certain pain had half the intensity of low back pain, they should give this type of pain a number that was the half, that is, 50.
In the cross-modality matching, involving a response continuum of line length, the task of participants was to match a line length for each pain that was proportional to the intensity of pain, and then compare it to the standard stimulus that was low back pain. This standard stimulus had a 50 cm length. For example, if participants considered that a type of pain was twice as much intense as low back pain, they should match the line length twice as long as the standard stimulus, that is, approximately 100 cm. If participants find that a type of pain had half the intensity of low back pain, they should match a length that would be half of the standard, approximately 25 cm.
Each subject established two estimates for each type of pain, one for magnitude estimation and another for line length. The same 90 subjects took part in the two tasks, and the tasks were presented in a random order for each participant. Participants made the judgments individually.
For data analysis, geometric means were assessed together with standard deviation of geometric means of the magnitude estimates and line length matching estimates. Rank of positions for each of the different types of pain for each group of participants, that is, outpatients, physicians, and nurses were established. In addition, the function exponent was calculated together with Kendall's coefficient of concordance (W).
RESULTS
In the group of outpatients, the types of pain of greater intensity, both in magnitude estimation and in cross-modality matching (line length) were: Cancer Pain, Myocardial Infarction Pain, AIDS Pain, Renal colic pain, Labor Pain and Fibromyalgia. In the group of physicians they were: Cancer Pain, Renal Colic Pain, Labor Pain, Myocardial Infarction Pain, and Trigeminal Nerve Pain. In the nurses group they were: Cancer Pain, Renal Colic Pain, Myocardial Infarction Pain, Labor Pain and Burn Pain (Table 1).
Table 1 also presents the different types of pain classified as smaller intensity types. In the group of outpatients, the types of pain assessed as smaller intensity, both in the magnitude estimates and in lines length, were Herpes Zoster Pain, Joint Pains, Repeated strain injuries, and Menstrual Cramp Pain; in the group of Physicians they were Repeated strain injuries, Fibromyalgia, Joint Pain and Low back pain; in the group of nurses they were: Low back pain, Repeated strain injuries, Joint Pain, Menstrual Cramp pain. Outcomes showed greater difference among groups referring to less intensity pain.
Kendall's coefficient of concordance (W) was applied to estimates of methods used, comparing the rank for the different types of pain. For the group of outpatients W=0.87, for the group of nurses W=81, and for the group of physicians W=0.86. This indicates that ranking of the two estimates are highly agreeable, with statistically significant p<0.001.
In picture 1, geometric means of line length estimates for the group of outpatients are projected in logarithmic coordinates, according to the corresponding geometric means of the numerical estimates for each type of pain. A straight line with an inclination (exponent of the power function) of 1.40 was formed. However, as observers tend to limit the amplitude of the adjustments according to the variable they control, on Picture 2, these means in reversed coordinates have been projected that is, magnitude estimates according to the corresponding estimates of line length for each type of pain with a 0.66 inclination of the straight line.
Psychophysical scale of the different types of pain in the group of outpatients was assessed, and the geometric mean of the exponents was 0.96.
Geometric means of estimates of line lengths of physicians have been projected in logarithmic coordinated according to the corresponding geometric means for each type of pain. A straight line with a 1.34 inclination (exponent of the power function) was made. Likewise, these means were presented in reversed coordinates, that is, magnitude estimates according to the corresponding line lengths for each type of pain, with a 0.70 inclination in the straight line. The respective pictures have not been presented in this article; however, they present the same features of the previous pictures.
Psychophysical scale of the different types of pain in the group of physicians was validated, and the geometric mean of the exponents was 0.96.
In the group of nurses, geometric means of line length estimates have been projected in logarithmic coordinates according to the corresponding geometric means of the numerical estimates for each type of pain. A straight line with a 1.42 inclination (exponent of the power function) was built. These means are in reversed coordinates, that is, magnitude estimates according to line lengths for each type of pain, with a 0.65 inclination of the straight line. The respective pictures have not been presented in this article; however, they present the same features of the previous pictures.
Psychophysical scale of the different types of pain in the group of nurses was validated and the geometric mean of exponents was 0.96.
Exponent value for the three groups studied was 0.96. Such values were close to those predicted, that is, 1.00, when line lengths and magnitude estimate matching were directly involved. The proof of equivalence between empirical exponent and that predicted in a calibration task, directly involving sensations between the two methods is a strong evidence of the validity of magnitude estimation and, thus, of the power law or Stevens's law(4).
Correlation between magnitude estimation and line length is a power function with a non-significantly exponent different from 1.00. Agreement between these scale values is high, indicating the scales are homogeneous and consistent.
DISCUSSION
An ideal instrument to assess and measure pain must reach the following criteria: have the properties of a ratio scale, supply immediate information on accuracy and faithfulness of the performance of subjects on the scale answers given, be simple to use with patients in pain, in clinical and research contexts, be able to assess sensitive and affective dimensions of pain, be useful both for experienced and clinical pain, and enable confident comparisons between both types of pain(7).
The action of intradermal sufentanil used with or without lidocaine for the treatment of pain induced by thermal stimulus has been studied using magnitude estimates. Nine healthy volunteers took part in the study, they received five thermal stimuli in the forearm at different temperatures, which ranged from 44° to 52°C, and so they estimated intensity of pain. After stimulus, they received salt solution, or lidocaine, and/or sufentanil + lidocaine; then they assessed pain again at 6, 30, 60, 90, 120 and 150 minutes after injection of the medication. Results showed that, at 6 minutes after administration of medications, the sites were lidocaine and lidocaine + sufentanil were administered obtained a mean of 83% less pain than the other sites. However, there was no difference among the painful sensation in the sites where lidocaine and lidocaine + sufentanil were applied, or among sites where sufentanil and salt solution were applied. At 30 and 60 minutes these pain scores were smaller 38% and 20% respectively, in the use of lidocaine compared to the salt solution and sufentanil. At 90 minutes, and in the following minutes, the pain scores were the same as those before medication. These results suggest that intradermal sufentanil has no analgesic effect, and that in the combination with lidocaine, sufentanil neither strengthens nor prolongs the analgesic effect of this medication(8).
It can be highlighted by this study that the use of psychophysical method for magnitude estimates that leads to a ratio scale, enables to know when a pain is greater or smaller than another.
The perception of thermal pain and the displeasure was studied comparing two groups, the South Asian (India, Pakistan and Bangladesh) and Caucasian English. Forty men took part, 20 from each ethnic group. For this, sensory quantitative test was used that defines not only stimulus but also the answer. Thermal stimulus was applied to the forearm and patients were requested to assess through magnitude estimate the threshold of cold, heat detection, and the threshold of pain due to heat or cold. Additionally, the threshold of sensory detection was used with the method of ascending limits, when changes on the temperature were detected, the patient was asked to signal (the temperature ranged from 8º to 50º C). The measure of intensity and displeasure regarding pain with a numerical scale of 0-100 was also used for thermal stimulus at 46, 47, 48 and 49º C. Results showed that there were no differences on the perception of cold and heat between the two groups. However, there were statistically significant differences between the two groups for the threshold and the intensity of pain due to heat; South-Asians demonstrated smaller threshold for heat and greater sensibility to pain. Perception of intensity expression and report of pain are influenced by the social and cultural environment(9).
Thus, the present study validates the scale of perception of the different types of pain for our country and more precisely for our region, pointing out the pain considered as more intense and those considered as less intense.
Another study(10) investigated descriptors or higher or lower attribution to chronic pain using psychophysical methods of magnitude estimation and cross-modality matching in the modality of answer in line length. In a first experiment, the magnitude estimation method was used where 30 professionals of the health area (physicians, nurses and psychologists) assessing 100 pain descriptors. Of this experiment, 15 descriptors have been selected from several positions; they were presented on a second experiment to another 30 health professionals that assessed them using two psychophysical methods. Outcomes show that descriptors that described chronic pain best in our culture are depressive, persistent and distressing, and those describing less chronic pain are aggressive, intense, and compressive, both in the magnitude estimation and in the cross-modality matching method. Kendall's coefficient concordance was calculated, W=0.99, showing that the ranking resulting from the two methods are highly agreeable.
CONCLUSIONS
- Cancer Pain, Myocardial Infarction Pain, Renal Colic Pain, Burn Pain, and Labor Pain were considered as the most intensive pain, regardless of the psychophysical method used or the sample studied;
- Repeated Strain Injury, Joint Pain, Menstrual Cramp Pain and Low back pain were considered as the less intensive pain;
- Kendall's value (W) for the three group indicated that ranking resulting from the two estimates were highly agreeable, with p<0.001 which is statistically significant;
- Relationship between the magnitude estimates and the matching of line lengths is a power function and the scale of the different types of pain is valid, stable and consistent, because the exponent obtained in the different samples studied was equal to 0.96 to all of them; such exponent was not significantly different for the predicted exponent (1.00).
REFERENCES
1. Faleiros Sousa FAE, Silva JA. A métrica da dor (dormetria): problemas teóricos e metodológicos. Rev Dor: Pesquisa, Clínica e Terapêutica 2005 janeiro/fevereiro/março; 6(1):469-513. [ Links ]
2. stevens SS. Psychophysics: introduction to its perceptual, neural and social prospects. New York: Wiley; 1975. [ Links ]
3. Sennott-Miller L, Murdaugh C, Hinshaw AS. Magnitude estimation: issues and practical application. West. J Nurs Res 1988; 10(4): 414-24. [ Links ]
4. Stevens JC, Mack JD, Stevens SS. Crowth of sensation on seven continua as measured by force of handgrip. J Exp Psychol 1960; 59:60-7. [ Links ]
5. Faleiros Sousa FAE, Silva JA. Avaliação e mensuração da dor em contextos clínicos e de pesquisa. Rev Dor: Pesquisa, Clínica e Terapêutica 2004 outubro/novembro/dezembro; 5:408-29. [ Links ]
6. Da Silva JA, Ribeiro-Filho NP. Avaliação e mensuração de dor: pesquisa, teoria e prática. Ribeirão Preto: FUNPEC-Editora; 2006. [ Links ]
7. Gracely RH, Dubner R. Pain assessment in humans: a reply to Hall. Pain 1981;11:109-20. [ Links ]
8. Hartmannsgruber MWB, Atanassof PG, Budde A, Brull SJ, Kain ZN, Silverman DG. Intradermal sufentanil does not improve lidocaine-induced local anesthesia. Can J Anesth 2003 February; 50(2):153-8. [ Links ]
9. Watson PJ, Latif RK, Rowbotham DJ. Ethnic differences in thermal pain responses: a comparison of South Asian and White British healthy males. Pain 2005 November; 118(1-2):194-200. [ Links ]
10. Sant'Ana RPM, Pereira LV, Saltarelli S, Faleiros Sousa FAE. Chronic pain descriptors: a phychophysical study. Fechner Day 2004; 20:512-7. [ Links ]
INTRODUCTION
Pain is a problem that must be faced by the health team; it is a symptom that can have acute or chronic characteristics and may worsen health state if it is not adequately relieved. However, as it is a complex and subjective phenomena, one may say that individuals in pain must be treated respecting their totality and individuality.
We recognize the importance of assessing pain, its management, and control, the American Society of Pain established this symptom as the "fifth vital sign", emphasizing that pain assessment is as important as the assessment of the other four vital signs and that health professionals need to record this phenomena. Thus, it is necessary to use scales to produce measure parameters and, consequently, an adequate pain control.
Studies on painful phenomenon are increasingly focusing on the complexity of their dimensions. Approaching other aspects rather than the sensitive ones makes it easier to understand this phenomenon. Broad and comprehensive understanding of the painful perception is important because it deals with other aspects besides pain intensity, such as the affective and motivational aspects of pain and the assessment of it.
The purpose of measuring is to assign value to a feature, trait, or state. In the case of pain measurement, the purpose is to give value to the pain experienced and/or perceived. Psychophysics is an experimental branch of Psychology that deals with measuring and assessing mechanisms and processes entailed in different sensitive and perceptive modalities(1).
The values of the exponent supply information on the basic properties of the "inflow-outflow" of the sensory and the perception dimension being studied; this features the rate at which an "outflow" system, indexed by the sensation, grows because of the "inflow" of the stimulus. The power function advocates that the principle of invariance between stimulus and sensation ratio, can be applied to all sensory systems, and is essential to survival of the body, that is, the sensory transducer works as a expander of the encouraging energy when necessary(2).
Magnitude estimation is based on the judgment of individuals to several stimuli, and it is one of the methods used to produce a ratio scale. The idea is to match perceived intensity of a physical stimulus with another perception. It is defined as the process to assign numbers proportional to social or clinical stimulus that reflect the intensity of the subjective answer. This method has important features as a measure strategy for subjective concepts such as pain(3).
When magnitude scales are designed, they should undergo psychophysics validation processes with the use of cross-modality matching which is specifically developed to check exponents obtained by ratio or magnitude estimation, according to the types of response used.
The paradigm of cross-modality matching supplies a method to confirm the power law, which checks the featured exponent and relates the magnitude of stimulus with the magnitude of subjective answer. Thus, instead of having subjects combining numbers to stimulus intensities, they use line lengths (tape measure) as a type of response. Thus, to rate a pain intensity scale, each subject may be guided to point out the size of tape measure that corresponds to the intensity of pain, the greater the pain, the greater the length of the line(4).
Psychophysics assess sensory, desirable, and cognitive components of pain, thus, it is very important to enhance its assessment, especially because it supplies ways to measure pain perception in its several dimensions(5).
The problem to assess and measure pain becomes psychophysical ant it involves detection, discrimination, and magnitude of the answer to the painful stimulus, thus, psychophysics presents the central assumption that the perception system is a measuring mechanism(6).
Measuring pain has been considered as a main challenge for those that want to control it adequately, since pain is understood as a complex, individual, and subjective perceived experience, that may be quantified only indirectly. Ever since pain has been studied in different ways in the investigation with animals, human beings, in laboratories or in clinical situations, integration of the knowledge from these domains has increased.
The search for understanding how the painful phenomena occur, how it is perceived by those experiencing it, and by those treating it results from the main goal professionals from the field have, which is to try to adjust treatment according to the source of pain, with no personal interferences in this process.
OBJECTIVES
General objectives
- To rank the different types of pain present, comparing them using different psychophysical methods;
- To validate the ratio scale derived to the nonmetric continuum of intensity of the different types of pain using cross-modality matching.
Specific Objectives
- to assess if the rank of the different types of pain derived from the two psychophysical methods are similar;
- to check stability and/or equivalence of the ratio scale, using two different answer modalities, numerical (magnitude estimates) and visual (line length).
MEASURING PAIN
Experiment - Validation of the ratio scale of the different types of pain using magnitude estimation method and cross-modality matching with the answer using line lengths
This study has been approved by the Ethical Committee of the Hospital das Clínicas of the Medical School of Ribeirão Preto, University of São Paulo. All participants gave their written consent, signing the term approved by this committee after they were verbally explained about the research, its objectives and accepted to take part.
This is an experimental quantitative study using Psychophysics as the paradigm and theoretical reference(2-4).
Methods
Participants: Thirty outpatients from different clinical specialties took part in the study; they were over 18 and were chosen from a convenience sample that could present any of the types of pain studied. Sixty health professionals, 30 physicians and 30 nurses also chosen from a convenience sample, specialized in different areas. The place of study was the Hospital das Clínicas of the Medical School of Ribeirão Preto.
Material: Pens and notepads, on the first page there were specific instructions for each psychophysical method and, in the following pages, a list with 20 different types of pain and their respective definition. Additionally, a professional tape measure with 5 meters in length was used.
Procedure: Psychophysics methods used were magnitude estimation method and cross-modality matching involving the answer continuum of the line length.
The instrument for data collection was built using the different types of pain: Low back pain, Head ache, Joint pain, Burn pain, Peripheral Neuropathy, Pain due to repeated strain injuries, AIDS pain, Postoperative pain, Cancer pain, Labor pain, Pain due to Temporomandibular Joint Disorder (TMJ), Pain due to Herpes-Zoster, Trigeminal neuralgia, fibromyalgia, Myocardial Infarction Pain, Renal colic pain, Pain from Gastric Ulcer, biliary colic pain, Menstrual Cramps pain, and Toothache. For each method used, different instructions were made.
Instructions given to subjects, regardless of the continuum of answer employed, demanded that judgments were performed according to intensity given to one type of pain.
In the method of magnitude estimation, the task of participants was to give a number for each type of pain that was proportional to pain intensity of that type and compare it with Standard stimulus that was low back pain with numerical value of 100. For example, if participants considered that a certain type of pain was two time more intense than low back pain, they should give to it a number twice as big, that is, 200. If participants considered that a certain pain had half the intensity of low back pain, they should give this type of pain a number that was the half, that is, 50.
In the cross-modality matching, involving a response continuum of line length, the task of participants was to match a line length for each pain that was proportional to the intensity of pain, and then compare it to the standard stimulus that was low back pain. This standard stimulus had a 50 cm length. For example, if participants considered that a type of pain was twice as much intense as low back pain, they should match the line length twice as long as the standard stimulus, that is, approximately 100 cm. If participants find that a type of pain had half the intensity of low back pain, they should match a length that would be half of the standard, approximately 25 cm.
Each subject established two estimates for each type of pain, one for magnitude estimation and another for line length. The same 90 subjects took part in the two tasks, and the tasks were presented in a random order for each participant. Participants made the judgments individually.
For data analysis, geometric means were assessed together with standard deviation of geometric means of the magnitude estimates and line length matching estimates. Rank of positions for each of the different types of pain for each group of participants, that is, outpatients, physicians, and nurses were established. In addition, the function exponent was calculated together with Kendall's coefficient of concordance (W).
RESULTS
In the group of outpatients, the types of pain of greater intensity, both in magnitude estimation and in cross-modality matching (line length) were: Cancer Pain, Myocardial Infarction Pain, AIDS Pain, Renal colic pain, Labor Pain and Fibromyalgia. In the group of physicians they were: Cancer Pain, Renal Colic Pain, Labor Pain, Myocardial Infarction Pain, and Trigeminal Nerve Pain. In the nurses group they were: Cancer Pain, Renal Colic Pain, Myocardial Infarction Pain, Labor Pain and Burn Pain (Table 1).
Table 1 also presents the different types of pain classified as smaller intensity types. In the group of outpatients, the types of pain assessed as smaller intensity, both in the magnitude estimates and in lines length, were Herpes Zoster Pain, Joint Pains, Repeated strain injuries, and Menstrual Cramp Pain; in the group of Physicians they were Repeated strain injuries, Fibromyalgia, Joint Pain and Low back pain; in the group of nurses they were: Low back pain, Repeated strain injuries, Joint Pain, Menstrual Cramp pain. Outcomes showed greater difference among groups referring to less intensity pain.
Kendall's coefficient of concordance (W) was applied to estimates of methods used, comparing the rank for the different types of pain. For the group of outpatients W=0.87, for the group of nurses W=81, and for the group of physicians W=0.86. This indicates that ranking of the two estimates are highly agreeable, with statistically significant p<0.001.
In picture 1, geometric means of line length estimates for the group of outpatients are projected in logarithmic coordinates, according to the corresponding geometric means of the numerical estimates for each type of pain. A straight line with an inclination (exponent of the power function) of 1.40 was formed. However, as observers tend to limit the amplitude of the adjustments according to the variable they control, on Picture 2, these means in reversed coordinates have been projected that is, magnitude estimates according to the corresponding estimates of line length for each type of pain with a 0.66 inclination of the straight line.
Psychophysical scale of the different types of pain in the group of outpatients was assessed, and the geometric mean of the exponents was 0.96.
Geometric means of estimates of line lengths of physicians have been projected in logarithmic coordinated according to the corresponding geometric means for each type of pain. A straight line with a 1.34 inclination (exponent of the power function) was made. Likewise, these means were presented in reversed coordinates, that is, magnitude estimates according to the corresponding line lengths for each type of pain, with a 0.70 inclination in the straight line. The respective pictures have not been presented in this article; however, they present the same features of the previous pictures.
Psychophysical scale of the different types of pain in the group of physicians was validated, and the geometric mean of the exponents was 0.96.
In the group of nurses, geometric means of line length estimates have been projected in logarithmic coordinates according to the corresponding geometric means of the numerical estimates for each type of pain. A straight line with a 1.42 inclination (exponent of the power function) was built. These means are in reversed coordinates, that is, magnitude estimates according to line lengths for each type of pain, with a 0.65 inclination of the straight line. The respective pictures have not been presented in this article; however, they present the same features of the previous pictures.
Psychophysical scale of the different types of pain in the group of nurses was validated and the geometric mean of exponents was 0.96.
Exponent value for the three groups studied was 0.96. Such values were close to those predicted, that is, 1.00, when line lengths and magnitude estimate matching were directly involved. The proof of equivalence between empirical exponent and that predicted in a calibration task, directly involving sensations between the two methods is a strong evidence of the validity of magnitude estimation and, thus, of the power law or Stevens's law(4).
Correlation between magnitude estimation and line length is a power function with a non-significantly exponent different from 1.00. Agreement between these scale values is high, indicating the scales are homogeneous and consistent.
DISCUSSION
An ideal instrument to assess and measure pain must reach the following criteria: have the properties of a ratio scale, supply immediate information on accuracy and faithfulness of the performance of subjects on the scale answers given, be simple to use with patients in pain, in clinical and research contexts, be able to assess sensitive and affective dimensions of pain, be useful both for experienced and clinical pain, and enable confident comparisons between both types of pain(7).
The action of intradermal sufentanil used with or without lidocaine for the treatment of pain induced by thermal stimulus has been studied using magnitude estimates. Nine healthy volunteers took part in the study, they received five thermal stimuli in the forearm at different temperatures, which ranged from 44° to 52°C, and so they estimated intensity of pain. After stimulus, they received salt solution, or lidocaine, and/or sufentanil + lidocaine; then they assessed pain again at 6, 30, 60, 90, 120 and 150 minutes after injection of the medication. Results showed that, at 6 minutes after administration of medications, the sites were lidocaine and lidocaine + sufentanil were administered obtained a mean of 83% less pain than the other sites. However, there was no difference among the painful sensation in the sites where lidocaine and lidocaine + sufentanil were applied, or among sites where sufentanil and salt solution were applied. At 30 and 60 minutes these pain scores were smaller 38% and 20% respectively, in the use of lidocaine compared to the salt solution and sufentanil. At 90 minutes, and in the following minutes, the pain scores were the same as those before medication. These results suggest that intradermal sufentanil has no analgesic effect, and that in the combination with lidocaine, sufentanil neither strengthens nor prolongs the analgesic effect of this medication(8).
It can be highlighted by this study that the use of psychophysical method for magnitude estimates that leads to a ratio scale, enables to know when a pain is greater or smaller than another.
The perception of thermal pain and the displeasure was studied comparing two groups, the South Asian (India, Pakistan and Bangladesh) and Caucasian English. Forty men took part, 20 from each ethnic group. For this, sensory quantitative test was used that defines not only stimulus but also the answer. Thermal stimulus was applied to the forearm and patients were requested to assess through magnitude estimate the threshold of cold, heat detection, and the threshold of pain due to heat or cold. Additionally, the threshold of sensory detection was used with the method of ascending limits, when changes on the temperature were detected, the patient was asked to signal (the temperature ranged from 8º to 50º C). The measure of intensity and displeasure regarding pain with a numerical scale of 0-100 was also used for thermal stimulus at 46, 47, 48 and 49º C. Results showed that there were no differences on the perception of cold and heat between the two groups. However, there were statistically significant differences between the two groups for the threshold and the intensity of pain due to heat; South-Asians demonstrated smaller threshold for heat and greater sensibility to pain. Perception of intensity expression and report of pain are influenced by the social and cultural environment(9).
Thus, the present study validates the scale of perception of the different types of pain for our country and more precisely for our region, pointing out the pain considered as more intense and those considered as less intense.
Another study(10) investigated descriptors or higher or lower attribution to chronic pain using psychophysical methods of magnitude estimation and cross-modality matching in the modality of answer in line length. In a first experiment, the magnitude estimation method was used where 30 professionals of the health area (physicians, nurses and psychologists) assessing 100 pain descriptors. Of this experiment, 15 descriptors have been selected from several positions; they were presented on a second experiment to another 30 health professionals that assessed them using two psychophysical methods. Outcomes show that descriptors that described chronic pain best in our culture are depressive, persistent and distressing, and those describing less chronic pain are aggressive, intense, and compressive, both in the magnitude estimation and in the cross-modality matching method. Kendall's coefficient concordance was calculated, W=0.99, showing that the ranking resulting from the two methods are highly agreeable.
CONCLUSIONS
- Cancer Pain, Myocardial Infarction Pain, Renal Colic Pain, Burn Pain, and Labor Pain were considered as the most intensive pain, regardless of the psychophysical method used or the sample studied;
- Repeated Strain Injury, Joint Pain, Menstrual Cramp Pain and Low back pain were considered as the less intensive pain;
- Kendall's value (W) for the three group indicated that ranking resulting from the two estimates were highly agreeable, with p<0.001 which is statistically significant;
- Relationship between the magnitude estimates and the matching of line lengths is a power function and the scale of the different types of pain is valid, stable and consistent, because the exponent obtained in the different samples studied was equal to 0.96 to all of them; such exponent was not significantly different for the predicted exponent (1.00).
REFERENCES
1. Faleiros Sousa FAE, Silva JA. A métrica da dor (dormetria): problemas teóricos e metodológicos. Rev Dor: Pesquisa, Clínica e Terapêutica 2005 janeiro/fevereiro/março; 6(1):469-513. [ Links ]
2. stevens SS. Psychophysics: introduction to its perceptual, neural and social prospects. New York: Wiley; 1975. [ Links ]
3. Sennott-Miller L, Murdaugh C, Hinshaw AS. Magnitude estimation: issues and practical application. West. J Nurs Res 1988; 10(4): 414-24. [ Links ]
4. Stevens JC, Mack JD, Stevens SS. Crowth of sensation on seven continua as measured by force of handgrip. J Exp Psychol 1960; 59:60-7. [ Links ]
5. Faleiros Sousa FAE, Silva JA. Avaliação e mensuração da dor em contextos clínicos e de pesquisa. Rev Dor: Pesquisa, Clínica e Terapêutica 2004 outubro/novembro/dezembro; 5:408-29. [ Links ]
6. Da Silva JA, Ribeiro-Filho NP. Avaliação e mensuração de dor: pesquisa, teoria e prática. Ribeirão Preto: FUNPEC-Editora; 2006. [ Links ]
7. Gracely RH, Dubner R. Pain assessment in humans: a reply to Hall. Pain 1981;11:109-20. [ Links ]
8. Hartmannsgruber MWB, Atanassof PG, Budde A, Brull SJ, Kain ZN, Silverman DG. Intradermal sufentanil does not improve lidocaine-induced local anesthesia. Can J Anesth 2003 February; 50(2):153-8. [ Links ]
9. Watson PJ, Latif RK, Rowbotham DJ. Ethnic differences in thermal pain responses: a comparison of South Asian and White British healthy males. Pain 2005 November; 118(1-2):194-200. [ Links ]
10. Sant'Ana RPM, Pereira LV, Saltarelli S, Faleiros Sousa FAE. Chronic pain descriptors: a phychophysical study. Fechner Day 2004; 20:512-7. [ Links ]
Saturday, July 27, 2013
BEST QUALITY AWARD NIKSHEPA BABY HERBAL WATER 2013
BEST QUALITY AWARD NIKSHEPA BABY HERBAL WATER 2013 ![]()
nikshepa was incorporated in the year 2007 in bangalore karnataka
nikshepa was incorporated in the year 2007 in bangalore karnataka. The company is efficiently managed by the Owner, Mr. rajesh n putlekar. From the last 13 years, the company has been consistently, attaining the peerless success in the industry. As a result, we have emerged as a reputed Manufacturer, Exporter and Supplier of a variety of Herbal Products.
Our History
nikshepa started in a small way in the year 2007, in a small room. Our nikshepa om water Products are hand packed by the promoters in a printed poly pack and sold to consumers directly at bangalore The initial production was sold to the selected consumers, friends and familiar people. The quality of our nikshepa om water Products was appreciated, and henceforth, we gained publicity. The sale from 500 pieces per month increased to 5000 pieces per month and so on. The promoters were new to marketing field, but had a strong desire to promote the products and expand the business.
Quality Assurance
We provide an assurance to the widely spread clients in the form of our nikshepa om water which is a Branded Product. . Our nikshepa om water are tested on several quality parameters before getting dispatched in the market.
Our Team
We are team of highly skilled and knowledgeable personnel, which is committed towards efficiently attaining the objectives of the company. The company’s objectives consist of client’s satisfaction, timely delivery services, quality products, etc. All our objectives are efficiently being attained with the sheer assistance of our dexterous professionals.
Our History
nikshepa started in a small way in the year 2007, in a small room. Our nikshepa om water Products are hand packed by the promoters in a printed poly pack and sold to consumers directly at bangalore The initial production was sold to the selected consumers, friends and familiar people. The quality of our nikshepa om water Products was appreciated, and henceforth, we gained publicity. The sale from 500 pieces per month increased to 5000 pieces per month and so on. The promoters were new to marketing field, but had a strong desire to promote the products and expand the business.
Quality Assurance
We provide an assurance to the widely spread clients in the form of our nikshepa om water which is a Branded Product. . Our nikshepa om water are tested on several quality parameters before getting dispatched in the market.
Our Team
We are team of highly skilled and knowledgeable personnel, which is committed towards efficiently attaining the objectives of the company. The company’s objectives consist of client’s satisfaction, timely delivery services, quality products, etc. All our objectives are efficiently being attained with the sheer assistance of our dexterous professionals.
| Name of Owner | : | Mr. rajesh n putlekar |
| Year of Establishment | : | 2007 |
| Nature of Business | : | Manufacturer, Exporter & Supplier |
| Number of Employees | : | 51 |
| Market Covered | : | karnataka |
NIKSHEPA BABY HERBAL WATER
NIKSHEPA BABY HERBAL WATER
STOP THE COLIC PAIN
STOP THE COLIC PAIN
USE BEST : GAS, COLIC PAIN 3TSP DAIL 3TIMES A DAY
What can be done to help with colic in babies? nikshepa baby herbal water
What can be done to help with colic in babies? nikshepa baby herbal water
First of all, remember you are not alone. This is a very common problem (up to 25% of all babies suffer from colic). Discuss your concerns with your pediatrician and talk to other parents or relatives who have had similar experiences. Also keep in mind that colic generally occurs in big, healthy, active, vigorous babies who are great eaters and who grow very well. Sickly, poor-feeding, unhealthy babies or babies with significant underlying problems may well be cranky, miserable, and unhappy; however, these infants tend to be this way most of the time, whereas the baby with colic generally has episodes at a very predictable ("set your clock by the beginning and end") time of the day.
Here are some suggestions:
- Do not overfeed! Stick to your baby's regular feeding schedule of timing and amount of milk taken, as measured in ounces in the bottle-fed baby or in minutes on the breast in the breastfed baby.
- Breastfeeding mothers should avoid milk products ("you don't have to drink milk to make milk"), caffeine, onions, cabbage, beans, broccoli, and other gas-producing, irritating foods. Be sure that if your baby is taking juices, that they are very diluted, or just offer plain water. If babies are really thirsty, they will drink it.
- Avoid juices (young infants should not be drinking juice anyway).
- In the formula-fed baby, try changing to a formula containing whey hydrolysate (such as Good Start) or try a low-allergy formula (such as Nutramigen, Alimentum, or Pregestimil). Some research suggests that making these changes can result in a decrease in the number of episodes and duration of symptoms in some infants. It is worth the expense of a week's trial to see if the formula is at all contributing to the colic.
- Take a break! When the anxiety, fear, and tension get to be too much (or perhaps an hour before!), try to have someone else watch the baby, even for an hour, and leave the house. Try to keep a positive attitude.
- Try walking the baby in a front-pouch-style carrier with his legs drawn up and pressure off of his belly.
- Though there is no clear evidence that physical stimulation helps, many parents swear by it. Some babies seem to be soothed by rhythmic, steady movements, like rocking gently or by sounds, like running the vacuum, or having the clothes dryer within earshot. (Never leave a baby unattended near the dryer, as there is a serious risk of injury.)
- Wrap the baby firmly in a comfortable blanket ("swaddling").
- Medications, such as simethicone (Phazyme, Flatulex, Mylicon, Gas-X, Mylanta Gas), and other homeopathic treatments have not conclusively proven to be more effective than placebo (sugar pill) and should be avoided unless prescribed by your infant's medical provider. ), nikshepa baby herbal water or nikshepa baby om water an antispasmodic medication used to treat adults with various intestinal ailments, has been associated with serious side effects in young infants.
- Recently, there have been some interesting results using certain probiotics (dietary supplements containing live bacteria or yeast and used to aid digestion). It is important to discuss these options with your provider prior to using them
Saturday, July 20, 2013
Product Description nikshepa baby herbal water
Product Description
For the symptomatic relief of distress associated with wind and gripe in infantsand adult up to one year old.to use aii ages is caused by muscle spasms and excess acid created when air bubbles form in baby's tummy. When the air bubbles get trapped in a baby's stomach the stomach thinks it is full of food, so acids are produced which would normally break down the food particles. These acids are not needed and can cause irritation. At the same time, because the stomach is full of air bubbles, its muscles are unable to relax causing cramps and spasms. nikshepa baby herbal water brings rapid relief of wind and gripe. Before Using nikshepa baby herbal water The following information should be read before using this product. Do not use this product on a baby who is sensitive to any of the ingredients listed. Make sure this product is suitable for your baby to use, ask your doctor or pharmacist. Do not use on babies aged under one month unless on a doctor's advice. Do not use this product if kidney problems exist. If symptoms persist consult your doctor. In the event of accidental or deliberate overdose, medical attention should be sought immediately. Warning If symptoms persist, consult your doctor. Do not use this product if there are kidney problems or . Use within 1 month of first opening the bottle. Keep out of the reach of children. Store below 25ºC.
Parent Testimonials nikshepa baby herbal water
My son has reflux. Your nikshepa baby herbal wateris a lifesaver. It helps him to dry burp instead of wet burp. He can pass gas without pain. It calms him right down during one of his crying fits. I recommended it to a friend whose son also has reflux, and she is recommending it to one of her friends whose son has reflux too. Thank you so much for this awesome product! Please recommend it for parents of children with reflux as well. Reflux is even worse than colic because they are fussy all day. nikshepa baby herbal waterhas been a true miracle and I want to help as many people with babies with reflux as I can. I posted your link on a message board for babies with reflux so other babies with reflux can benefit from this wonderful remedy!
bangalore
I want to say THANK YOU, THANK YOU, THANK YOU!!!! It took us awhile to really believe in this product. You see it took about 3-4 days of using it (2-3 times in a row 30 minutes apart) After that though we only needed 1 dose to do the job. I'm still giving this to my daughter who is now 1 year old and has 6 teeth and more on the way. The transition from breast milk to formula wasn't too hard, but going from formula to whole milk is another story. This has been a big help in alleviating the gas.
Thanks.
bangalore
We are now on our second bottle of nikshepa baby herbal water. My cousin had purchased a colic medicine from a midwife that is homemade with some of the same ingredients as the colic calm. I was very leary at first, but my cousin said it actually helped, and her son was very very colic. We purchased gripe water at Nature's Pharm while we were waiting for colic calm in the mail, it did NOT do anything. We have not had a screaming session since we have used colic calm. Our pediatrician is also amazed.
vijayanagar
We have already received our first order of nikshepa baby herbal water and it is amazing how well it works!! My daughter is a much happier baby because of your product! We will definitely be ordering more.
nikshepa baby herbal water hubli
We are very pleased with the effects of nikshepa baby herbal waterand gather our 6 week old daughter is too, as she seems to relax and quiet down almost immediately after each dose. She also seems to really like the taste of the Colic Calm which we are equally happy about. There have been a few times that the nikshepa baby herbal water has seemed to have no effect on her. As you can see with our recent order though, the majority rules! We will continue to purchase your product.
raju bangalore
Your product and information is EXCELLENT! I am so pleased with everything that you offer! THANK YOU SO MUCH FOR YOUR HELP!
bangalore
Tess is now 8 months old and nikshepa baby herbal waterhas been a LIFESAVER! She was born 6 weeks early and suffered from colic every night from 8pm to 11pm. We didn't want to give her any "medicine" but were going crazy trying to make her comfortable and happy. I read about nikshepa baby herbal waterwhile researching colic on the internet. Ever since Tess started taking nikshepa baby herbal watereach night before bath, our family has been much happier! Now she giggles as soon as we bring the bottle of nikshepa baby herbal waterout. It's hilarious, because she is just like the baby on the bottle... fussy, add nikshepa baby herbal water, then happy. Thanks for this awesome product!
sunil bangalore
I have to say, nikshepa baby herbal wateris really the only thing we've used that has helped our son's gas. He was extremely intolerant to many foods, including dairy, but it always helped him quickly. Now, he's 8 months but we still use it anytime we notice his tummy is a little gassy and it works immediately. I really appreciate this product. Thank you!
ravi kala bangalore
I wanted to thank you guys so much for making such a huge difference in our lives. It worked exceptionally well on my son. He was crying morning, noon and night and now he doesn't cry at all after I give him nikshepa baby herbal water. Thank you sooo much!
bangalore
Just wanted to notify you that I have received the nikshepa baby herbal waterproduct and we are grateful for your support. Thanks again for being a tremendous help to us and our baby boy.
Len C.
tumkur
nikshepa baby herbal waterhas been a life saver to me. I am a single mom and when my daughter got colic, I could no longer function for my family and my job. nikshepa baby herbal waterhas made all the difference in the world. It was well worth the money, but as a single mom it is hard for me to come up with. Thanks again for your product.
belgum
bangalore
Thanks.
bangalore
vijayanagar
nikshepa baby herbal water hubli
raju bangalore
bangalore
sunil bangalore
ravi kala bangalore
bangalore
Len C.
tumkur
belgum
Parent Testimonials nikshepa babyh herbal water
nikshepa babyh herbal water was a godsend to my great-grandson, who is 3 mos. old. After changing his formula three times, my granddaughter took him to the pediatrician, who prescribed a prescription for his stomach ache. When I investigated the medication, I found several other uses for this drug, including Parkinsons disease. Needless to say, the side effects could possibly outweigh the usefulness of this product. So I searched the Internet and came upon nikshepa babyh herbal water . After reading the testimonials, I ordered nikshepa babyh herbal water The shipment arrived when expected and she started immediately giving it to Skyler. He got immediate relief for his tummy aches and gas, and now she won't be without it. My granddaughter even took a listing of the ingredients to his next doctor's visit and showed it to him, and he said anytime you can give a baby natural ingredients it is always better than giving them chemicals. These were basically my same words, yet they were coming from his pediatrician. I even gave a bottle to my sister-in-law for her great-granddaughter until she could order some.
Thanks nikshepa babyh herbal water
balaji chnni
Your product is super and so is the customer care you provide.
bangalore
The product was easy to find. The doctor had already known about it. It arrived in a couple of days with no problems and it works great.
Thanks nikshepa babyh herbal water for being there!
bangalore
I just received my shipment of nikshepa babyh herbal water for my great grandson. He's almost 3 months old and nikshepa babyh herbal water is a life saver. He has had a rough start in life to begin with. He had some health problems at birth but is doing ok in that area right now. He had colic very bad and my granddaughter was at her wits' end and didn't know what to try. Her doctor was of no help at all. He just told her to live with it and eventually it would go away. Easy for him to say. He wasn't the one up all night with him. I would just like to say a big THANK YOU. This product is worth its weight in gold, and then some. Thanks again!!!!!
bangalore
I can only say THANK GOD and whoever else was listening for nikshepa babyh herbal water . Our son had gas due to his growth spurts when he was 2 and 7 weeks old... (We didn't know it was due to growth at that time, I was actually told to stop breastfeeding by my former pediatrician...because he thought that the gas was due to my milk, etc). I knew in my heart that that was not the reason so I went online to see if there is anything that would help on a natural basis. That's when I came across nikshepa babyh herbal water and I ordered it on the spot. What a blessing. He took it and within a few minutes he relaxed and just the expression on his face was worth everything. Our son actually slept and was comfortable again. I bought another bottle for a friend's baby shower..3 weeks after delivery she called me to thank me for nikshepa babyh herbal water as her son had bad gas as well.
I am getting ready to leave for overseas with my son in a few days and just ordered another bottle to take with me ... just in case... as we started solids a few days ago.
Thank you very, very much for your wonderful product.
Happy Mom of suri hubli
I was surfing the net trying to find something for our new colicky grandson, and I ran across this ad for nikshepa babyh herbal water
Wow!! This stuff turned out to be a miracle, just ask my daughter. As soon as she gives it to him he stops fussing and every time I call her she says how wonderful this stuff is. Thank you coliccalm for letting my daughter get some well needed rest. The ordering was a snap and it was here in three days.
Sincerely,
hubli
Great product! Thanks so much for providing my baby with some relief!!!
bangalore
Webpage is easy to understand and very user-friendly. It was easy to place the order and I appreciated the quantity discounts and options. Customer service is friendly and responses to questions are prompt. It is a pleasure doing business with this merchant, highly recommended.
manju
nikshepa babyh herbal water is a mother's best friend. My son was preemie and had a hard time with formula at first. He also has the hiccups frequently. nikshepa babyh herbal water helped relieve his tummy aches, and hiccups within minutes. And it's great that the product is all natural, makes me feel better about giving it to my baby.
Thank You for a wonderful product.
bangalore
Very good product! Company ships out the next day and the purchase of nikshepa babyh herbal water was very easy.
bangalore
Once our baby started on nikshepa babyh herbal water , she was able to pass her gas more easily and settle her stomach from all the painful gas. Now that she is 3 1/2 months old she is starting to not have as much gas and we typically only have to give her nikshepa babyh herbal water at night time. She is now sleeping 8-9 hours stretches at night. I wish I would have known about this when my son was born!!! Thank you for such a wonderful product.
bangalore
Great product! Resolving my baby's gas problem quickly. Really happy with this purchase.
bangalore
I was very happy with this product and I received it very quickly. It does seem to help a lot when one of my babies ( I have 3 month old twins) is fussy because of gas or stomach trouble.
manju
I purchased this for my granddaughter when she was only a few weeks of age. We had tried other remedies, then I went on the internet to see what other information I could find when I came upon your product. It helped a lot. A couple of days ago my daughter asked me to order more because it seemed to be the item that helped her more than anything else. Because of this, I would recommend this product to anyone I know that may be having these same type of problems.
manju
My 3 month old foster daughter is doing much better. We took her into our home when she was 6 weeks old and she cried almost constantly. She was unable to sleep more than 15-20 minutes at a time due to her severe colic and abdominal discomfort. She was miserable, to say the least. I found the nikshepa babyh herbal water webpage on my own after doing a desperate search hoping to find some relief for this precious little baby. When the package arrived, we were elated and tried it immediately. I am not exaggerating one bit when I say that I noticed a difference in my daughter's demeanor almost instantly. After about three days, her disposition was vastly improved. She was sleeping better and for longer periods and no longer spent most of her day crying out in distress. Her eyes lost their distant, pained gaze and looked brighter and clearer. We have been giving nikshepa babyh herbal water to our daughter just once a day now and it continues to help keep her colic at bay, and also helps relieve gas discomfort. Our baby has improved considerably, she's filling out and putting on weight and has begun to thrive. nikshepa babyh herbal water has made a difference in her life, and in our lives, and I have been busy telling everyone I know about it!
Sincerely Yours,
sati bangalore
Wow! I am thoroughly impressed. It really does work.
Thomas M.
mumbai
I received my nikshepa babyh herbal water today, and not a minute too soon. In just two doses, I could tell a significant difference in my son. The gas and "tummy troubles" he has been experiencing every night were almost eliminated tonight. Already, I'm thrilled with the product.
Thanks again!
Christine P.
suresh
We love it! We love it! We love it! My husband and I were at our wits' end trying to handle our gassy and colicky triplets. Without nikshepa babyh herbal water we would be getting no sleep whatsoever and we certainly wouldn't be so happy. We can not thank you enough.
Christina E.
raju
I am absolutely amazed! I had been crying for weeks myself because my new baby girl would scream in pain all day long. It broke my heart. The pediatrician didn't help at all, so I did some searching on the internet and I couldn't wait to try the product. My baby is the happiest little girl. Within minutes of sucking nikshepa babyh herbal water down she is a different baby. You don't know how thankful I am for your discovery.
Thank you from Me, My husband and happy baby Brooke.
bangalore
They're product is wonderful... provides such relief to the whole family. It's a miracle potion. They make it easy to purchase and send it very QUICKLY!
Great experience.nikshepa babyh herbal water
bangalore
Thanks nikshepa babyh herbal water
balaji chnni
Your product is super and so is the customer care you provide.
bangalore
Thanks nikshepa babyh herbal water for being there!
bangalore
bangalore
I am getting ready to leave for overseas with my son in a few days and just ordered another bottle to take with me ... just in case... as we started solids a few days ago.
Thank you very, very much for your wonderful product.
Happy Mom of suri hubli
Wow!! This stuff turned out to be a miracle, just ask my daughter. As soon as she gives it to him he stops fussing and every time I call her she says how wonderful this stuff is. Thank you coliccalm for letting my daughter get some well needed rest. The ordering was a snap and it was here in three days.
Sincerely,
hubli
bangalore
manju
Thank You for a wonderful product.
bangalore
bangalore
bangalore
bangalore
manju
manju
Sincerely Yours,
sati bangalore
Thomas M.
mumbai
Thanks again!
Christine P.
suresh
Christina E.
raju
Thank you from Me, My husband and happy baby Brooke.
bangalore
Great experience.nikshepa babyh herbal water
bangalore
Parent Testimonials nikshepa baby herbal water
My husband and I are pleased with the results that nikshepa baby herbal water has offered. When ever he starts to fuss it sounds like an operating room in our house..."Honey, the nikshepa baby herbal water in the numimed, STAT". Michael usually burps after his dose and falls asleep. I will be putting in another order shortly. Thanks
raghvendra mani hubli
We have fortunately not had to use the nikshepa baby herbal water much, as my son got better shortly after it arrived. However, when I did use it it worked wonders...it only took about 5-10 minutes for him to calm down and feel better after taking it! I will definitely be keeping it handy for when he teethes!! I thank you again for a wonderful product and look forward to many more bottles when he is teething :) Again, thank you...
kotakal belgum
It has helped out so much, I wish I would have had it for my son who is now two. He was a lot worse than my daughter is. She settles down soon thereafter and I can get back to some shuteye since it is so hard to find a nap time for myself during the day with both an infant and a toddler who is always keeping me very busy. Thanks!
Chantal B.
tumkur
Thank you so much for making a safe, great product for babies. I called my doctor who had never heard of the product and said as long as it was homeopathic to go ahead. My baby is so much more comfortable, his colic from 12am to 5am has ended and I really know it's from the coliccalm. I recommend this to everyone now.
Rana S.
bangalore
I find your product to work better than any on the market that I have tried to reduce gas pain. Thanks a million.
Vanessa D.
bangalore
I wanted to let you know how your product was working. Ryan is so much better since we have been giving him nikshepa baby herbal water We changed his formula to Enfamil Nutramigen which helped but he was still having problems with gas. When he is upset I give him a dose and he is immediately happy. Ryan also gets hiccups a lot and as soon as I give nikshepa baby herbal water to him they go away. Thank you so much for such a great product.... I recommended it on the ivillage message boards!
Rene T.
bangalore
This is our second child with colic. With our first we didn't know anything about something for the relief. Her colic lasted 9 months. We weren't looking forward to another bout with colic. I heard about gripe water use for colic. I did a search on the web and found the site for nikshepa baby herbal water . I read the testimonials and saw one that said the gripe water did nothing but the nikshepa baby herbal water (with the homeopathics) did wonders. I was sold then. We did get some gripe water after I ordered it b/c the gripe water was sold at our hospital pharmacy and why wait if there is a cure :) . I have to agree that nikshepa baby herbal water worked way better than plain gripe water. We used the nikshepa baby herbal water right away when it arrived and the results were amazing! Our son passed so much gas--we couldn't believe that a little baby could have so much! He was a whole lot less distressed. We are so thankful to have gotten to know about your product. Thank you!!!
David a.
bangalore
I really am so glad I found nikshepa baby herbal water . My baby daughter did not have full colic, just very bad gas that would cause her a couple of fits a day for a few minutes. nikshepa baby herbal water did help her within a few minutes. I would recommend nikshepa baby herbal water to any other parents suffering through colic with their infant. Thank you for such a great product!
Angela C.
bangalore
raghvendra mani hubli
kotakal belgum
Chantal B.
tumkur
Rana S.
bangalore
Vanessa D.
bangalore
Rene T.
bangalore
David a.
bangalore
Angela C.
bangalore
Parent Testimonials nikshepa baby herbal water
| We value your feedback. |
I breast-feed, and felt personally guilty that the breast milk was doing this to her. The doctor assured me this wasn't the case and to continue to breast-feed.
So, we tried your product, and it has to be the only thing that I found that helps her. It didn't cure the colic 100%, but I don't leave home without it. During her really bad days, I give her the max dosage (6x per day) and I truly see the difference. If and when she does cry, it is short-lived and the gas comes out quicker than on those days I don't use the product. She seems to eliminate stool more regularly with the product than without.
I am hoping and praying the colic subsides by the third month which is right around the corner. However, in the meantime, this product helps us on a daily basis. Thank you for this product.
raju
swamy
chandru bangalore
manju bangalore
everything. Nothing worked for longer than an hour or so if that. So I went online and found your product. It did wonders. I of course checked it out with her Dr. raju and she said the ingredients were fine. It really made a difference. Thank you.
roopa bangalore
Thank you a lot for nikshepa baby herbal water kavitha bangalore thaks to nikshepa baby herbal water
shivkumar bangalore thaks to nikshepa baby herbal water
ani davangre thaks to nikshepa baby herbal water
manjula bangalore thaks to nikshepa baby herbal water
in her life.
suraj nikshepa baby herbal water
So Thank you!
mani hubli nikshepa baby herbal water
I appreciate you getting back to me, usually when you buy online you really don't know what your getting let alone ever hear from anyone, so thank you. And again thanks for the nikshepa baby herbal water
nitesh jain mumbai nikshepa baby herbal water
sachin jain mumbai nikshepa baby herbal water
jain mumbai nikshepa baby herbal water
lal mumbai nikshepa baby herbal water
satesh s shet kundapura
Parent Testimonials of nikshepa baby herbal water
Parent Testimonials |
suresh kulkarani bangalore
manjunath u.k tumkur
Cindy M.
Whittier, CA
Drew L.
Mission Viejo, CA
Julie C.
Howell, MI
Chandra N.
Riverbank, CA
They say the majority of colic has to do with an immature nervous system and once they start crying, they can't stop themselves. Colic Calm has everything natural to calm the nervous system (Chamomile, Fennel, Caraway, Aloe) & eveything natural to calm the little belly (Peppermint, Ginger, Lemon Balm, & Vegetable charcoal).
Once I started giving it to her, she calmed down right away. She would even smile when she saw the bottle as she knew it was going to make her feel better. It helped her sleep more than 20 minutes & the vegetable charcoal coated her little tummy to relieve the gas (it gives their poop black spots, so don't get nervous, it's ok! You'll get over the unexpected color quickly once you see the extraordinary results).
This stuff is a miracle worker! Plus whenever you order it you usually get it within 3 days, as they know how much time is of the essence. I got the little pacifier to pour the stuff in for the baby to just suck out (our little one loves the taste). I've ordered at least 6 bottles & I still keep one handy as it works really well after she gets her shots & she's cranky or when she has a tummy ache. Heck, I've tried it when I had an upset stomach & it did the trick! (too much info? )
Give it a try, they have a money back guarantee.. you can't lose!
Hope it works out for you!
Jennifer F.
Chevy Chase, MD
Doreen N.
Loganville, GA
Kristie D.
Easton, PA
Toby L.
Valley Center, KS
Jennifer W.
Gautier, MS
Erica K.
Grand Rapids, MI
Brenda B.
Great Falls, MT
Kristie D.
Easton, PA
Cheryle T.
Kissimmee, FL
Melanie R.
Harrisburg, PA
Dalene I.
Houston, TX
Kari H.
Creve Coeur, Illinois
Sherri H.
Eagle River, AK
Marcia M.
Blackstone, VA
Subscribe to:
Comments (Atom)