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gastrointestinal stromaltumors: recurrence patternsand prognostic factors forsurvival. Am Surg. 2000(Jan); 231(1): 51-8.10 Croonn KF, Perry CM.Imatinib Mesylate in theTreatment of GastrointestinalStromal Tumors. Drugs.2003; 63(5): 513-22 discussion523-4.11 Demetri GD, Van ooosteromAT, et al. Efficacy and safetyof sunitinib in patients withadvanced gastrointestinalStromal Tumor after failureof imatinib: a randomizedcontrolled Trial. Lancet. 2006Oct 14; 368(9544): 1329-38.Pankaj SharmaDepartment of RadiologyDeen Dayal Hospital, NewDelhiPain relief during laborMusic -Historical records revealthat the ancient Greeksplayed soothing instrumentalmusic to women in labour. Musiccan have a relaxing effect inlabour due to its ability to altermood, reduce stress and promotepositive thoughts. It canbe used as a trigger for a breathingresponse or as a cue for relaxation.It may also be used asa distraction although this is aless effective use for music inlabour. Music can be comfortingnot only for you, but alsofor your supportersHeat and cold-Two furthersimple ways of easing pain andassisting relaxation duringlabour are through the applicationof heat and cold. They providea source of counterstimulation.Heatcan be appliedin several ways:l by taking a hot shower orbathl via a hot water bottle or hotwet towel over the abdomenl by applying a hot compressover the perineumInstead of applying heat to theskin, some women find thatcold is more soothing. A cool,damp face-cloth is always refreshing,while an ice pack caneasily be applied to the lowerback.Imagery -Creative mental activity,known as imagery, canalso be used to encourage relaxationand help women managetheir pain during labour.Many people use imagery ineveryday situations. For example,when we feel hungry wecan often ‘see’ (visual imagery)and ‘taste’ (taste imagery) animagined meal in front of us -even to the extent of makingour mouths water. The wordimagery (or visualisation) impliesthat only the visual senseis used. However, all senses (vision,touch, hearing, taste andsmell) can be included in thismental activity.Rhythmical movements-Many women find that rhythmicalmovement helps to easepain during labour. This is notsurprising because the movementis a common response inother painful circumstances.Likewise, during labour, manywomen instinctively have astrong urge to be active. Movementprovides a source ofcounter-stimulation and maystimulate the release of endorphinswithin the nervous system.For example, rocking thepelvis backwards and forwardsduring contractions is oftenfound to be soothing. This canbe performed while standing,sitting, kneeling, lying down oron hands and knees.Otherrhythmical movements includetapping your fingers, rubbingyour abdomen, breathing rhythmicallyand stamping your feet.Some women find it helps tocount, sing, shout or howl at thesame time!. Whichever manoeuvreappeals to you, the actionshould be rhythmical and repetitive,and make you feel better.TENS-Transcutaneous ElectricalNerve Stimulation (TENS)provides yet another form ofcounter-stimulation and hasbeen used for several years inthe management of postoperativeand cancer pain. It has beenpostulated that TENS helps torelieve pain by stimulating therelease of endorphins. TheTENS equipment consists of asmall, battery driven pulse generator,connected to one or twopairs of electrodes which areattached to the skin with adhesivetape. When it is turned on,the TENS machine causes a tinglingsensation underneath theelectrodes - the strength ofwhich can be adjusted at thegenerator controls. TENS ismost useful during labour inhelping to relieve pain. Conse-82Journal of Postgraduate Medical Education, Training & ResearchVol. II, No. 5, September-October 2007