***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM The aim of the study was to evaluate the effect of cooling the soft tissue of injection sites on the pain perceptions of pediatric patients during the administration of local anesthesia for routine dental procedures . METHODS AND MATERIAL S A total of 160 children aged 5 - 6 years were included in the present study . On a r and om basis , the subjects were allocated to the without ice pretreatment ( WIP ) group ( topical anesthesia + counterstimulation + distraction ) or the ice pretreatment ( IP ) group ( cooling + topical anesthesia + counterstimulation + distraction ) . During the administration of an inferior alveolar nerve block , the children 's behavior was assessed using the sound , eye , and motor ( SEM ) scale . The statistical analysis of data was performed based on the analysis of variance ( ANOVA ) . RESULTS There were no significant differences within the groups between the values of the sound , eye , and motor components for either the WIP or the IP groups ( P>0.05 ) . All three components of the SEM in the IP group were consistently lower than the WIP group ( P<0.05 ) . Moreover , the SEM value for the WIP group surpassed the IP group ( P<0.05 ) . CONCLUSIONS Cooling the site of infiltration block prior to the injection of local anesthesia significantly reduced the pain perceived during injection of local anesthetic agent in pediatric patients . CLINICAL SIGNIFICANCE Pre-cooling of the soft tissues of an injection site prior to the administration of a local anesthetic can minimize the discomfort and anxiety associated with the injection procedure and facilitates the management of pediatric patients during this phase of a dental procedure The purpose of this study was to clarify the effects of anxiety about dental treatment on pain during treatment . Subjects consisted of 57 consenting sixth- grade students at Tokyo Dental College ( male : 32 , female : 25 ) , all of whom participated in this study during their clinical training program . They knew how third molars were extracted and all had experience of assisting in tooth extraction . Prior to the study , trait anxiety in the subjects was evaluated according to the State-Trait Anxiety Inventory ( STAI , Japanese version ) . The students were asked to read one of two scenarios describing a scene in which a third molar was extracted while imagining themselves to be the patient . Scene 1 is set in an " environment where the patient feels safe and comfortable , " and the Scene 2 is set in an " environment where the patient feels strong anxiety " . The subjects were asked to imagine the anxiety and pain in that scenario and evaluate that pain according to a visual analogue scale ( VAS ) . Two scenarios were r and omly shown to the subjects in a crossover manner . No significant correlation between trait anxiety and preoperative anxiety was observed . There was no difference in level of preoperative anxiety for Scene 1 and Scene 2 between the high- and low-trait anxiety groups . This suggests that there was no relationship between sensitivity to anxiety as a characteristic of the subject and amplitude of anxiety immediately prior to treatment . Scene 2 elicited significantly higher anxiety before injection of regional anesthesia , significantly higher pain during insertion of the needle , and significantly higher pain during extraction of the tooth than Scene 1 . This difference suggests that patients feel stronger pain if anxiety in the treatment environment is high and that it is , therefore , important to reduce anxiety during treatment to reduce pain PURPOSE To examine prospect ively the incidence of digital infa rct ion and phentolamine rescue in a large series of patients in whom local anesthesia with adrenaline was injected electively into the h and and fingers . There continues to be a commonly held belief that epinephrine injection is contraindicated in the finger despite a lack of valid evidence to support this concept in the literature . METHODS From 2002 to 2004 there were 9 h and surgeons in 6 cities who prospect ively recorded each consecutive case of elective h and and finger epinephrine injection .  They recorded each instance of skin or tissue loss and the number of times  phentolamine reversal of adrenaline vasoconstriction was required . RESULTS There were 3,110 consecutive cases of elective injection of low-dose epinephrine ( 1:100,000 or less ) in the h and and fingers and none produced any instance of digital tissue loss .  Phentolamine was not required to reverse the vasoconstriction in any patients . CONCLUSIONS The true incidence of finger infa rct ion in elective low-dose epinephrine injection into the h and and finger is likely to be remote , particularly with the possible rescue with phentolamine OBJECTIVE : The goal was to test a multifaceted distraction method design ed to reduce injection-associated pain in school-aged children . METHODS : A clinical trial evaluated 41 children , 4 to 6 years of age , who were given 3 st and ard prekindergarten immunizations ; 21 were assigned r and omly to an office routine control group , whereas 20 received a multifaceted , discomfort-reducing intervention . The intervention added verbal suggestions of diminished sensation and a visual focusing activity to the use of ethyl chloride , an established pain-reducing measure . The distraction material s used for the intervention consisted of topical ethyl chloride spray , an improvised , plastic , multipronged arm gripper , and a vibrating instrument descending on the contralateral arm , which provided the focusing task and visual distraction . RESULTS : According to patient and parent Faces Pain Scale-Revised scores and nonblinded , video-taped observations scored according to the face-legs-activity-crying-consolability method , the intervention group showed highly significant reductions in pain and discomfort , compared with the control group ( patient self-report , P < .0013 ; parent report , P < .0002 ; observation score , P < .0001 ) . CONCLUSION : This multifaceted distraction intervention reduced significantly the pain and discomfort of childhood immunizations in children 4 to 6 years of age AIM The aim of this study was to investigate the influence of anxiety and type of dental injection , a plastic syringe or an electronic computerized device , on the  pain perceived by children . DESIGN Two dental injectors , a computerized device ( W and , Milestone Scientific , Livingston , NJ , USA ) and a traditional plastic syringe , were compared . Forty-one children , aged 9 - 13 years , who had registered for treatment in Marmara University , Istanbul , Turkey , were included in the study . Both anxious and non-anxious children were included in the study group . The Children 's Fear Survey Schedule-Dental Subscale , Facial Image Scale , Spielberger 's State Anxiety Index for Children , and heart rates were used to determine the anxiety levels . Participants were assigned to interventions by using r and om allocation . The first appointment was design ed as an introductive familiarization session and injections were administered in the second and third sessions , with one or the other injector . The visual analogue scale was used for pain measurement after injections . RESULTS No significant differences in injection pain scores were observed between the W and and traditional plastic injector . Higher levels of pre-injection anxiety were found to be related to more severe pain reports by the children . CONCLUSIONS Anxiety plays an important role in the pain reaction of children , and was found to be more determinative in pain perception than the injection devices preferred BACKGROUND The " gate control " theory suggests pain can be reduced by simultaneous activation of nerve fibres that conduct non-noxious stimuli . This study investigated the effects of vibration stimuli on pain experienced during  local anaesthetic injections .  METHODS In a preliminary study , subjects were asked to rate anticipated and actual pain from regional anaesthetic injections in the oral cavity . A second study compared , within subjects , pain from injections with and without a simultaneous vibration stimulus . Both infiltration and block anaesthetic injection techniques were assessed . In each subject , two similar injections were given and with one , a vibration stimulus was r and omly allocated . Injection pain was assessed by visual analogue scale and McGill pain descriptors . RESULTS Both infiltration and block injections were painful ( mean anticipated intensity : 31.25 , actual : 17.82 mm on 100 mm scale ) . Pain intensity with and without vibration was 12.9 mm ( range 0 - 67 ) and 22.2 mm ( range 0 - 83 ) respectively ( p = 0.00005 , paired T-test ) , and this effect was seen with both infiltration ( p = 0.032 ) and block anaesthetic ( p = 0.0001 ) injection subgroups . Furthermore , compared to no vibration-stimulus injections , injections with vibration result ed in less pain descriptors chosen ( p = 0.004 ) , and the descriptors had a lower pain rating ( p = 0.001 ) . CONCLUSIONS The results suggest that vibration can be used to decrease pain during dental local anaesthetic administration Local anesthetics can produce pain during skin infiltration . We design ed a r and omized , prospect i ve trial to determine whether needle gauge and /or solution pH affect pain during the intradermal infiltration of lidocaine . After approval by our institution 's human studies review board , 40 healthy adult volunteers gave their consent to participate in this study . All of the volunteers r and omly received four intradermal injections . Each volunteer was blinded as to the content of the intradermal injections and to which needle size was used for each injection . Each volunteer r and omly received a 0.25-mL intradermal injection of the following four solutions : 1 ) lidocaine 2 % administered through a 25-gauge needle ( lido-25 ) ; 2 ) lidocaine 2 % mixed with sodium bicarbonate ( 4 mL of 2 % lidocaine plus 1 mL of sodium bicarbonate , pH 7.26 ) administered through a 25-gauge needle ( lido-bicarb-25 ) ; 3 ) lidocaine 2 % administered through a 30-gauge needle ( lido-30 ) ; and 4 ) lidocaine 2 % mixed with sodium bicarbonate ( 4 mL of 2 % lidocaine plus 1 mL of sodium bicarbonate ) administered through a 30-gauge needle ( lido-bicarb-30 ) . In each patient , the injection site was in the same region for each of the four injections . The skin wheal was tested for appropriate anesthesia using a 19-gauge needle on the skin wheal . A visual analog pain score was recorded after each intradermal injection . The pain scores were significantly higher in the lido-25 ( 3.2 + /- 0.2 ) group than in the lido-30 ( 2.5 + /- 0.3 ) , lido-bicarb-25 ( 1.9 + /- 0.2 ) , and lido-bicarb-30 ( 1.3 + /- 0.2 ) groups . The lido-bicarb-30 injection was also rated as less painful than the lido-30 injection . We found no differences between the lido-bicarb-25 and the lido-bicarb-30 injections . Complete analgesia for the 19-gauge needle pain stimulus was achieved in all patients for each injection . We conclude that , overall , the pain intensity of an intradermal injection of 2 % lidocaine is low . The addition of sodium bicarbonate to 2 % lidocaine decreases the pain associated with an intradermal skin wheal , and although the use of a 30-gauge needle decreases the pain of injection , the addition of sodium bicarbonate seems to have a greater overall effect than needle size . Implication s : Forty volunteers r and omly received four intradermal injections consisting of 2 % lidocaine with or without sodium bicarbonate via a 25- or 30-gauge needle . The addition of bicarbonate had a greater overall effect than needle size in decreasing the pain associated with the intradermal injection of lidocaine . ( Anesth Analg 1998;86:379 - 81 This study on low contamination wounds was conducted to compare the pain of local infiltration anaesthesia administered into the skin surrounding the wound with administration directly into the incised edges of the wound . Eighty-one adult patients were r and omized by date of presentation to receive  infiltration anesthesia by one of the two methods . Pain of anesthetic administration was rated on a visual analogue scale and recorded as a pain score in millimeters . The results demonstrated that the average pain score for infiltration into the wound was significantly lower than the average pain score for infiltration into skin surrounding the wound Needle insertion is a very common invasive procedure , but little has been done to study how pain is related to the mechanical properties of the needle insertion , and how pain from the procedure may be minimized . The aim of the present study was to investigate the pain evoked by  st and ardized needle insertion into the human skin .  Needle insertions were performed with continuous registration of the mechanical force on the needle . Forty consecutive needle insertions to the depth of 8 mm with 27 G and 30 G needles , 2 and 19 mm/s velocities , and at 45 and 90 degree angles to the skin surface were performed in a r and omized and blinded design in 30 healthy volunteers . The occurrence , intensity and quality of pain , as well as the maximum mechanical needle penetration force and the total mechanical workload were registered . The mechanical parameters of needle insertions were significantly related to needle size and velocity of insertion . Occurrence of pain and bleeding were significantly related to the needle size . High needle insertion velocity was significantly related to a higher rate of sharp and pricking pain , and low insertion velocity to a significantly higher rate of dull and 
    Output:
    
There are now excellent techniques for minimizing anesthetic injection pain , with supporting evidence varying from anecdotal to systematic review s. Medical students and residents can easily learn techniques that reliably limit the pain of local anesthetic injection  to the minimal discomfort of only the first fine needlestick .
By combining many of these conclusions and techniques offered in the literature , tumescent local anesthetic can be administered to a substantial area such as a h and and forearm for tendon transfers or a face for rhytidectomy , with the patient feeling just the initial poke