Acupressure for Pain, Injection Fear, and Satisfaction in Intramuscular Injection Patients

Effect of Acupressure Therapy on Pain, Injection Fear, and Post-Injection Satisfaction in Patients Undergoing Intramuscular Injection: A Randomized Controlled Trial

Background: Intramuscular (IM) injection-related pain and anxiety continue to be common problems in nursing practice. Non-pharmacological interventions such as acupressure are increasingly recognized for their potential to reduce procedure-related discomfort and enhance patient satisfaction.

Aim: This study is planned to evaluate the effects of acupressure therapy on pain, injection-related fear, and post-injection satisfaction among patients receiving IM injections.

Methods: This study is designed as a randomized controlled trial to be conducted with 68 patients presenting to the emergency department and requiring IM diclofenac sodium injection. Participants will be randomly assigned to either an intervention group (n = 34), which will receive acupressure at the GB30 (Huantiao) point prior to injection, or a control group (n = 34), which will receive standard care. Data will be collected using the Visual Analog Scale, Injection Fear Scale, and Post-Injection Satisfaction Scale.

Study Overview

• Status: Completed
• Conditions: Pain; Fear; Satisfaction
• Intervention / Treatment: Other: acupressure

Detailed Description

Intramuscular (IM) injections are among the most frequently performed parenteral medication administration methods by nurses worldwide, with billions of injections administered each year ( World Health Organization [WHO]). Despite their widespread use, IM injections continue to represent a significant source of pain, fear, and discomfort for patients. Injection-related pain is not limited to transient physical discomfort; it may also contribute to the development of injection fear, anxiety, and avoidance of future medical procedures. Pain is a universal human experience; however, its perception and expression vary across individuals. Furthermore, preinjection anxiety and fear significantly influence the pain experience. The act of needle penetration itself may trigger anxiety and, in some cases, lead to persistent fear of future injections. This fear can result in patients delaying or refusing injections, potentially compromising treat- ment adherence and recovery. Injection fear may lead individuals to avoid healthcare services, reduce adherence to prescribed treatments, and cause delays in care processes. These consequences are in direct conflict with the fundamental principles of patient-centered and evidence-based nursing care. Furthermore, pain and fear experienced during injections can negatively affect patient satisfaction, thereby reducing the perceived quality of care. Therefore, nurses are expected to apply evidence-based, patient-centered interventions during medication administration to reduce pain and improve patient outcomes. Several techniques have been recommended in the literature to minimize pain associated with IM injections, including correct injection site selection, appropriate patient positioning, slow drug administration, use of the Z-track technique, air- lock technique, distraction strategies, and complementary therapies. However, current evidence predominantly addresses pain intensity, while injection-related fear and postinjection satisfaction, which are key indicators of patient experience, remain under explored. Acupressure is a noninvasive technique that involves apply- ing pressure to specific points on the body using the fingers to alleviate or prevent pain. It is a low-cost and easily applicable complementary intervention that has been shown to be effective in pain management across various clinical contexts. In acupressure therapy, it is assumed that vital energy, referred to as Chi , flows throughout the body along energy channels known as meridians, which are named according to internal organs. Pressure applied to specific points along these meridians is believed to reduce tension and muscle stiffness in various parts of the body, enhance endorphin release, and modulate pain trans- mission pathways, thereby decreasing pain perception. However, there is a notable lack of studies comprehensively examining the effects of acupressure therapy on IM injection-related pain, injection fear, and postinjection satisfaction. The American Society for Pain Management Nursing emphasizes the importance of tailored, effective interventions for pain, anxiety, and fear management before, during, and after invasive procedures to enhance patient satisfaction. In this context, acupressure therapy represents a promising intervention for reducing pain perception during IM injections, alleviating injection-related fear, and ultimately enhancing postinjection satisfaction. To the best of our knowledge, no randomized con- trolled study has simultaneously examined the effects of acupressure on pain, injection-related fear, and postinjection satisfaction in patients receiving IM injections. Although various techniques have been explored to manage IM injection-related discomfort, the number of studies evaluating the effects of acupressure therapy on pain, injection-related fear, and postinjection satisfaction remains limited. Addressing this gap is critically important to support nurses in delivering evidence-based, holistic, and patient-centered care during IM injection practices. Therefore, this randomized controlled study was conducted to comprehensively evaluate the effects of acupressure therapy on pain, injection-related fear, and postinjection satisfaction in patients undergoing IM injections.

• Study Type: Interventional
• Enrollment (Actual): 68
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Cyprus
  • Famagusta, Cyprus, 34381
    • Eastern Mediterranean University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Were aged 18 years or older,
• Possessed sufficient physical and cognitive abilities to assess pain using the VAS,
• Had the ability to read and comprehend study instructions,
• Were newly prescribed IM Diclofenac Sodium (without prior doses),
• Had a body mass index within the normal or obese range ac- cording to WHO classification,
• Had no scars, wounds,

Exclusion Criteria:

Patients who had taken any analgesic medications on the day of injection were excluded.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: acupressure group; acupressure	Other: acupressure; Acupressure was applied to the GB30 point, which is anatomically located at the junction of the lateral one- third and medial two-thirds of the distance between the greater trochanter of the femur and the sacral hiatus. Pressure was applied using the thumb at an intensity sufficient to produce slight skin blanching without causing pain, consistent with previously published acupressure protocols. The pressure was applied continuously for 1 minute immediately prior to the IM injection. To ensure consistency and standardization, all acupressure applications were performed by the same researcher following a predefined protocol. Participants in the control group received routine IM injection care without acupressure intervention.
No Intervention: Control group; Standard injection procedure was performed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analog Scale	There is a significant difference in visual analog scale pain scores between patients in the acupressure group and those in the control group. 1 represents the lowest level of pain, and 10 represents the highest level of pain. As the number increases, the intensity of the pain also increases.	1 day
Fear Scale	There is a significant difference in injection fear scale scores between patients in the acupressure group and those in the control group. The scale is calculated based on the average item score. The lowest possible score on the scale is 1, and the highest is 5. As the score on the scale increases, the level of fear increases.	1 day
postinjection satisfaction scale	There is a significant difference in postinjection satisfaction scale scores between patients in the acupressure group and those in the control group. The lowest possible score on the scale is 1, and the highest is 5. As the score on the scale increases, the level of satisfaction increases. The Post-Injection Satisfaction Scale consists of 9 items.	1 day

Collaborators and Investigators

• Sponsor: Istanbul University - Cerrahpasa
• Investigators: Study Director: Seda C Cevheroglu, Assit. Prof, Eastern Mediterranean University

Study record dates

Study Major Dates

• Study Start (Actual): November 15, 2024
• Primary Completion (Actual): February 20, 2025
• Study Completion (Actual): February 20, 2025

Study Registration Dates

• First Submitted: March 24, 2026
• First Submitted That Met QC Criteria: March 29, 2026
• First Posted (Actual): April 1, 2026

Study Record Updates

• Last Update Posted (Actual): April 7, 2026
• Last Update Submitted That Met QC Criteria: April 1, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Behavior; Signs and Symptoms; Pain; Personal Satisfaction; Therapeutics; Complementary Therapies; Physical Therapy Modalities; Rehabilitation; Therapy, Soft Tissue; Musculoskeletal Manipulations; Acupressure
• Other Study ID Numbers: Doğu Akdeniz Üniversitesi

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No