Far From "Just a Poke": Common Painful Needle Procedures and the Development of Needle Fear

C Meghan McMurtry, Rebecca Pillai Riddell, Anna Taddio, Nicole Racine, Gordon J G Asmundson, Melanie Noel, Christine T Chambers, Vibhuti Shah, HELPinKids&Adults Team, N E MacDonald, J Rogers, L Bucci, P Mousmanis, S A Halperin, S Bowles, C Halpert, M Ipp, M Rieder, K Robson, M M Antony, V Dubey, A Hanrahan, D Lockett, J Scott, E Votta Bleeker, C Meghan McMurtry, Rebecca Pillai Riddell, Anna Taddio, Nicole Racine, Gordon J G Asmundson, Melanie Noel, Christine T Chambers, Vibhuti Shah, HELPinKids&Adults Team, N E MacDonald, J Rogers, L Bucci, P Mousmanis, S A Halperin, S Bowles, C Halpert, M Ipp, M Rieder, K Robson, M M Antony, V Dubey, A Hanrahan, D Lockett, J Scott, E Votta Bleeker

Abstract

Background: Vaccine injections are the most common painful needle procedure experienced throughout the lifespan. Many strategies are available to mitigate this pain; however, they are uncommonly utilized, leading to unnecessary pain and suffering. Some individuals develop a high level of fear and subsequent needle procedures are associated with significant distress.

Objective: The present work is part of an update and expansion of a 2009 knowledge synthesis to include the management of vaccine-related pain across the lifespan and the treatment of individuals with high levels of needle fear. This article will provide a conceptual foundation for understanding: (a) painful procedures and their role in the development and maintenance of high levels of fear; (b) treatment strategies for preventing or reducing the experience of pain and the development of fear; and (c) interventions for mitigating high levels of fear once they are established.

Results: First, the general definitions, lifespan development and functionality, needle procedure-related considerations, and assessment of the following constructs are provided: pain, fear, anxiety, phobia, distress, and vasovagal syncope. Second, the importance of unmitigated pain from needle procedures is highlighted from a developmental perspective. Third, the prevalence, course, etiology, and consequences of high levels of needle fear are described. Finally, the management of needle-related pain and fear are outlined to provide an introduction to the series of systematic reviews in this issue.

Discussion: Through the body of work in this supplement, the authors aim to provide guidance in how to treat vaccination-related pain and its sequelae, including high levels of needle fear.

Conflict of interest statement

Supported by the Canadian Institutes of Health Research (CIHR), Ottawa, ON, Canada (KRS 132031). Open access funding was provided by the Mayday Fund in the United States. A. Taddio declares a grant from Pfizer, and study supplies from Natus and Ferndale. C.T. Chambers declares consultation fees from Abbvie. E. Lang is a member of the GRADE working group and declares consultation fees from the International Liaison Committee on Resuscitation (ILCOR). L. Bucci declares a relationship with government agencies and grants from Merck, GSK, Novartis, Sanofi, and Pfizer. S.A. Halperin declares grants from GSK, Sanofi, Novartis, Pfizer, Merck, PREVENT, ImmunoVaccine, NovaVax, Janssen, and Folia. The remaining authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Needle procedures (eg, vaccine injections) across the lifespan. Predisposing, precipitating, perpetuating, and protective factors contribute to the entire needle context (shown in the patterned box) as they influence the clinician, parent, and child (eg, behaviors, experience). The critical role of a high degree of needle fear is highlighted. Unmitigated pain during these procedures may increase fear which in turn can exacerbate future pain in an escalating relationship. Thus, the consequences of unmitigated pain and fear during a given needle procedure extend beyond that particular procedure. Interventions in the systematic reviews in this series of articles are shown in gray-filled boxes; of note, the interventions for individuals with a high degree of needle fear must be implemented before the other interventions more proximal to the procedural context itself (ie, process, pharmacological, psychological, physical, procedural).

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