Music versus distraction for procedural pain and anxiety in patients with cancer. Comparison of the use of the Valsalva maneuver and the eutectic mixture of local anesthetics (EMLA®) to relieve venipuncture pain: a randomized controlled trial Psychological Interventions for Vaccine Injections in Children and Adolescents Can words hurt? Patient–provider interactions during invasive procedures The “Cough Trick:” A Brief Strategy to Manage Pediatric Pain From Immunization Injections Psychological interventions for needle-related procedural pain and distress in children and adolescents. Effect of communication on pain during intravenous cannulation: a randomized controlled trial. The subjective experience of pain: where expectations become reality. Ameliorating adults' acute pain during phlebotomy with a distraction intervention. Procedural and Physical Interventions for Vaccine Injections Evaluating the Efficacy of the Valsalva Maneuver on Venous Cannulation Pain: A Prospective, Randomized Study Out of sight, but not out of mind? Greater reported pain in patients who spontaneously look away during venepuncture. An Everyday Phrase May Harm Your Patients: The Influence of Negative Words on Pain During Venous Blood Sampling Reducing Venipuncture Pain by a Cough Trick: A Randomized Crossover Volunteer Study The impact of threatening information about pain on coping and pain tolerance. The effects of Valsalva manoeuvres on venepuncture pain How sharp is a "sharp scratch"? A mixed methods study of verbal warnings issued before venipuncture. A randomized controlled trial of analgesia during vaccination in adults. Intradermal normal saline solution, self-selected music, and insertion difficulty effects on intravenous insertion pain. Pain catastrophizing influences the use and the effectiveness of distraction in schoolchildren. The effects of imagery and sensory detection distractors on different measures of pain: how does distraction work? Cognitive-behavioral interventions for IV insertion pain. The Effect of Brief Functional Relaxation on College Students’ Needle Anxiety During Injected Vaccinations The Role of a Flash of Light for Attenuation of Venous Cannulation Pain: A Prospective, Randomized, Placebo-Controlled Study
PURPOSE / OBJECTIVES To test the hypotheses that the effects of a music intervention are greater than those of simple distraction and that either intervention is better at controlling procedural pain and anxiety than treatment as usual . DESIGN R and omized , controlled experiment . SETTING A midwestern comprehensive cancer center . SAMPLE 60 people with cancer having noxious medical procedures such as tissue biopsy or port placement or removal ; 58 provided usable data . METHODS Participants completed measures of pain and anxiety before and after their medical procedures and provided a rating of perceived control over pain and anxiety after the procedure . MAIN RESEARCH VARIABLES Procedural pain , state anxiety , and perceived control over pain and anxiety . FINDINGS Contrary to hypotheses , outcomes achieved with music did not differ from those achieved with simple distraction . Moreover , outcomes achieved under treatment as usual were not significantly different from those obtained with music or distraction interventions . Some patients found that the interventions were bothersome and reported that they wanted to attend to the activities of the surgeon and the medical procedure itself . CONCLUSIONS The effects of music , distraction , and treatment as usual are equivocal . In addition , patients have individual preferences for use of distraction during painful or anxiety-provoking procedures . IMPLICATION S FOR NURSING Patients having noxious medical procedures should be asked about their desire to be distracted before and during the procedure and offered a strategy that is consistent with their preferences Purpose Intravenous cannulation is a painful and stressful procedure . The objective of this study was to compare the analgesic efficacy of the eutectic mixture of local anesthetics ( EMLA ® ) with that of the Valsalva maneuver in adult patients during i.v . cannulation . Methods One hundred ninety-five patients were r and omized prospect ively to three groups . The dorsum of the nondominant h and was covered with a thick paste of 2.5 g of EMLA ® cream in the EMLA ® group ( group E ) and left for a minimum of 30 min before venipuncture . In the control group ( group C ) , the same procedure was applied except that Vaseline ® was used instead of the EMLA ® . The Valsalva group ( group V ) were punctured during a Valsalva maneuver . The patients were placed in the supine position during venipuncture . The patients then scored the amount of pain on cannulation using an 11-point numerical rating scale ( NRS ; 0 = no pain , 10 = extreme pain ) . Results Thirteen patients were excluded from the analysis due to failed cannulation . There was no difference in the demographic profiles of the groups ( p > 0.05 ) . The success of VP was significantly higher in group V than in groups E and C ( p < 0.001 ) . The median pain score as assessed by the NRS after venipuncture in group C was 3 ( range 0–9 ) , whereas the median pain values in groups E and V were 2 ( range 0–7 ) and 2 ( range 1–8 ) . Conclusions The Valsalva maneuver yields similar results to the EMLA ® in terms of pain reduction during venipuncture Background : This systematic review evaluated the effectiveness of psychological interventions for reducing vaccination pain and related outcomes in children and adolescents . Design / Methods : Data base search es identified relevant r and omized and quasi-r and omized controlled trials . Data were extracted and pooled using established methods . Pain , fear , and distress were considered critically important outcomes . Results : Twenty-two studies were included ; 2 included adolescents . Findings showed no benefit of false suggestion ( n=240 ) for pain ( st and ardized mean difference [ SMD ] −0.21 [ −0.47 , 0.05 ] ) or distress ( SMD −0.28 [ −0.59 , 0.11 ] ) , or for use of repeated reassurance ( n=82 ) for pain ( SMD −0.18 [ −0.92 , 0.56 ] ) , fear ( SMD −0.18 [ −0.71 , 0.36 ] ) , or distress ( SMD 0.10 [ −0.33 , 0.54 ] ) . Verbal distraction ( n=46 ) showed reduced distress ( SMD −1.22 [ −1.87 , −0.58 ] ) , but not reduced pain ( SMD −0.27 [ −1.02 , 0.47 ] ) . Similarly , video distraction ( n=328 ) showed reduced distress ( SMD −0.58 [ −0.82 , −0.34 ] ) , but not reduced pain ( SMD −0.88 [ −1.78 , 0.02 ] ) or fear ( SMD 0.08 [ −0.25 , 0.41 ] ) . Music distraction demonstrated reduced pain when used with children ( n=417 ) ( SMD −0.45 [ −0.71 , −0.18 ] ) , but not with adolescents ( n=118 ) ( SMD −0.04 [ −0.42 , 0.34 ] ) . Breathing with a toy ( n=368 ) showed benefit for pain ( SMD −0.49 [ −0.85 , −0.13 ] ) , but not fear ( SMD −0.60 [ −1.22 , 0.02 ] ) ; whereas breathing without a toy ( n=136 ) showed no benefit for pain ( SMD −0.27 [ −0.61 , 0.07 ] ) or fear ( SMD −0.36 [ −0.86 , 0.15 ] ) . There was no benefit for a breathing intervention ( cough ) in children and adolescents ( n=136 ) for pain ( SMD −0.17 [ −0.41 , 0.07 ] ) . Conclusions : Psychological interventions with some evidence of benefit in children include : verbal distraction , video distraction , music distraction , and breathing with a toy & NA ; Patients are often prepared for procedural discomforts with descriptions of pain or undesirable experiences . This practice is thought to be compassionate and helpful , but there is little data on the effect of such communicative behavior . This study assesses how such descriptions affect patients ' pain and anxiety during medical procedures . The interactions of patients with their healthcare providers during interventional radiological procedures were videotaped during a previously reported 3‐arm prospect i ve r and omized trial assessing the efficacy of self‐hypnotic relaxation .  One hundred and fifty‐nine videos of the st and ard care and attention control arms were review ed . All statements that described painful or undesirable experiences as warning before potentially noxious stimuli or as expression of sympathy afterwards were recorded . Patients ' ratings of pain and anxiety on 0–10 numerical scales ( 0=No Pain , No Anxiety at All and 10=Worst Pain Possible , Terrified ) after the painful event and /or sympathizing statement were the basis for this study . Warning the patient in terms of pain or undesirable experiences result ed in greater pain ( P<0.05 ) and greater anxiety ( P<0.001 ) than not doing so . Sympathizing with the patient in such terms after a painful event did not increase reported pain , but result ed in greater anxiety ( P<0.05 ) . Contrary to common belief , warning or sympathizing using language that refers to negative experiences may not make patients feel better . This conclusion has implication s for the training in medical communication skills and suggests the need for r and omized trials testing different patient – practioner interactions OBJECTIVE : The goal was to investigate the effect of a “ cough trick ” technique on self-reported pain of children receiving routine immunizations . The strategy requires minimal equipment , time , or training for parents , children , and nursing staff members . METHODS : A r and omized , controlled , unblinded , within-subject study of 68 children receiving prekindergarten ( ages 4–5 ) or pre – junior high school ( ages 11–13 ) immunizations was performed . Participants were recruited from an outpatient pediatric clinic at a large public hospital in the Midwest . The strategy required a single “ warm-up ” cough of moderate force , followed by a second cough that coincided with needle puncture . The principle outcome was self-reported pain , although parent and nurse report of pain was used to support the accuracy of self-report . Older participants and all nurses completed a measure of their satisfaction with the procedure . RESULTS : In the initial analysis , the procedure was found not to be effective . However , post hoc tests revealed that the procedure was effective at a statistically and clinical ly significant level for participants identified as Hispanic white or non-Hispanic white but not for those identified as non-Hispanic black . Participants and clinic nurses found the procedure acceptable and effective . CONCLUSIONS : The results of this study suggest that the cough trick can be an effective strategy for the reduction of pain for some children undergoing routine immunizations . However , additional research is needed to clarify the observed moderation by self-identified race For the current issue of the Journal , we asked Drs Anna Taddio and C Meghan McMurtry to comment on and put into context the Cochrane Review on psychological interventions for needle-related procedural pain and distress in children and adolescents ( 1 ) . Background This review is an up date d version of the original Cochrane review published in Issue 4 , 2006 . Needle-related procedures are a common source of pain and distress for children . Our previous review on this topic indicated that several psychological interventions were efficacious in managing paediatric needle pain including distraction , hypnosis and combined cognitive behavioural interventions . Considerable additional research in the area has been published since that time . Methods Search strategy Search es of the following data bases were conducted for relevant r and omized controlled trials ( RCTs ): Cochrane Central Register of Controlled Trials ( CENTRAL ) ; MEDLINE ; EMBASE ; PsycINFO ; the Cumulative Index to Nursing and Allied Health Literature ( CINAHL ) ; and Web of Science . Requests for relevant studies were also posted on various electronic list servers . An up date d search was conducted in March 2012 and again in March 2013 . Selection criteria Participants included children and adolescents two to 19 years of age undergoing needle-related procedures . Only RCTs with ≥5 participants in each study arm comparing a psychological intervention group with a control or comparison group were eligible for inclusion . Data analysis Two review authors extracted data and assessed trial quality , and a third author helped with data extraction and coding for one non-English study . Included studies were coded for quality using the Cochrane Risk of bias tool . St and ardized mean differences with 95 % CIs were calculated for all analyses using Review Manager version 5.2 . Results Thirty-nine trials with a total of 3394 participants were included . The most commonly studied needle-related procedures were veni-puncture , intravenous line insertion and immunization .  Studies included children two to 19 years of age , with the most evidence available for children < 12 years of age . Consistent with the original review , the most commonly studied psychological interventions for needle procedures were distraction , hypnosis and cognitive behavioural therapy ( CBT ) . The majority of included studies ( 19 of 39 ) examined distraction only . The additional studies from this review up date continued to provide strong evidence for the efficacy  of distraction and hypnosis . No evidence was available to support the efficacy of preparation and information , combined CBT ( ≥2 cognitive or behavioural strategies combined ) , parent coaching plus distraction , suggestion or virtual reality for reducing children ’s pain and distress . No conclusions could be drawn about interventions of memory alteration , parent positioning plus distraction , blowing out air or distraction plus suggestion because evidence was available from single studies only . In addition , the risk of bias scores indicated several domains with high or unclear bias scores ( eg , selection , detection and performance bias ) , suggesting that the method ological rigour and reporting of RCTs of psychological interventions continue to exhibit considerable room for improvement . Conclusions Overall , there is strong evidence supporting the efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents , with no evidence currently available for preparation and information or both , combined CBT , parent coaching plus distraction , suggestion or virtual reality . Additional research is needed to further assess interventions that have only been investigated in one RCT to date ( ie , memory alteration , parent positioning plus distraction , blowing out air and distraction plus suggestion ) . There are continuing issues with the quality of trials examining psychological interventions for needle-related pain and distress . The full text of the Cochrane Review is available in The Cochrane Library ( 1 ) BACKGROUND Clinicians frequently warn patients of discomfort before potentially painful procedures , despite the lack of evidence that such communications are helpful . We aim ed to compare two communications ( one with , and the other without , a warning of a ' sting ' ) immediately before i.v . cannulation in order to measure differences in perceived pain by patients during the procedure . METHODS R and omly assigned patients awaiting elective surgery received a communication immediately before i.v . cannulation consisting of either ' I am going to apply the tourniquet and insert the needle in a few moments . It 's a sharp scratch and it may sting a little ' ( Group S ) or ' I am going to apply the tourniquet on the arm . As I do this many people find the arm becomes heavy , numb and tingly . This allows the drip to be placed more comfortably ' ( Group NS ) . Cannulation pain was measured by a 0 - 10 verbal numerical rating score ( VNRS ) and five-point Likert scale . RESULTS Of 101 participants , 49 were allocated to Group S and 52 to Group NS .  Median VNRS pain scores with inter-quartile ranges ( IQR ) were 1 and 2 , respectively , for both groups . Median Likert scores were 3 in Group S and 2 in Group NS with an IQR of 1 for both groups ( P = 0.13 ) . Six participants vocalized pain in Group S and none in Group NS ( P = 0.01 ) . Three participants withdrew their arm spontaneously in Group S and none in Group NS ( P = 0.11 ) . CONCLUSIONS Warning patients of a ' sting ' before i.v . cannulation may not be helpful Our subjective sensory experiences are thought to be heavily shaped by interactions between expectations and incoming sensory information . However , the neural mechanisms supporting these interactions remain poorly understood . By using combined psychophysical and functional MRI techniques , brain activation related to the intensity of expected pain and experienced pain was characterized . As the magnitude of expected pain increased , activation increased in the thalamus , insula , prefrontal cortex , anterior cingulate cortex ( ACC ) and other brain regions . Pain-intensity-related brain activation was identified in a widely distributed set of brain regions but overlapped partially with expectation-related activation in regions , including the anterior insula and ACC . When expected pain was manipulated , expectations of decreased pain powerfully reduced both the subjective experience of pain and activation of pain-related brain regions , such as the primary somatosensory cortex , insular cortex , and ACC . These results confirm that a mental representation of an impending sensory event can significantly shape neural processes that underlie the formulation of the actual sensory experience and provide insight as to how positive expectations diminish the severity of chronic disease states This study evaluated the effectiveness of a distraction intervention on subjects ' perceptions of pain .  During phlebotomy , 96 adults received either usual care or used a kaleidoscope as a distraction . After phlebotomy they rated their level of experienced pain with each of three instruments : Wong-Baker FACES Pain Scale , pain visual analogue scale , and Present Pain Intensity Scale . Statistical analyses revealed significantly lower perceptions of experienced pain among subjects using the kaleidoscope and concurrent validity for using the FACES Pain Scale with adults . Because the distraction intervention is effective , inexpensive , and easy to implement , its routine use during phlebotomy is recommended Background : This systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination . Design / Methods : Data bases were search ed using a broad search strategy to identify relevant r and omized and quasi-r and omized controlled trials . Data were extracted according to procedure phase ( preprocedure , acute , recovery , and combinations of these ) and pooled using established methods . Results : A total of 31 studies were included . Acute infant distress was diminished during  intramuscular injection without  aspiration ( n=313 ) : st and ardized mean difference ( SMD ) −0.82 ( 95 % confidence interval [ CI ] : −1.18 , −0.46 ) . Injecting the most painful vaccine last during vaccinations reduced acute infant distress ( n=196 ) : SMD −0.69 ( 95 % CI : −0.98 , −0.4 ) . Simultaneous injections  reduced acute infant distress compared with sequential injections ( n=172 ) : SMD −0.56 ( 95 % CI : −0.87 , −0.25 ) . There was no benefit of simultaneous injections in children . Less infant distress during the acute and recovery phases combined occurred with vastus lateralis ( vs. deltoid ) injections ( n=185 ) : SMD −0.70 ( 95 % CI : −1.00 , −0.41 ) . Skin-to-skin contact in neonates ( n=736 ) reduced acute distress : SMD −0.65 ( 95 % CI : −1.05 , −0.25 ) . Holding infants reduced acute distress after removal of the data from 1 method ologically diverse study ( n=107 ) : SMD −1.25 ( 95 % CI : −2.05 , −0.46 ) . Holding after vaccination ( n=417 ) reduced infant distress during the acute and recovery phases combined : SMD −0.65 ( 95 % CI : −1.08 , −0.22 ) . Self-reported fear was reduced for children positioned upright ( n=107 ) : SMD −0.39 ( 95 % CI : −0.77 , −0.01 ) . Non-nutritive sucking ( n=186 ) reduced acute distress in infants : SMD −1.88 ( 95 % CI : −2.57 , −1.18 ) . Manual tactile stimulation did not reduce pain across the lifespan . An external vibrating device and cold reduced pain in children ( n=145 ) : SMD −1.23 ( 95 % CI : −1.58 , −0.87 ) . There was no benefit of warming the vaccine in adults . Muscle tension was beneficial in selected indices of fainting in adolescents and adults . Conclusions : Interventions with evidence of benefit in select population s include : no aspiration , injecting most painful vaccine last , simultaneous injections , vastus lateralis injection , positioning interventions , non-nutritive sucking , external vibrating device with cold , and muscle tension Pain associated with venous cannula is a distressing symptom . We evaluated the efficacy of the Valsalva maneuver on pain associated with venous cannulation . Seventy-five adults , ASA physical status I and II , either sex , undergoing elective surgery , were included in this study . Patients were r and omized into 3 groups of 25 each . Group I ( C ) : control ; Group II ( V ) : blew into sphygmomanometer tubing and raised the mercury column up to 30 mm Hg for 20 s ; Group III ( B ) : pressed a rubber ball . Twenty seconds later , peripheral venous cannulation was performed . Venous cannulation pain was grade d using a 4-point scale : 0–3 , where 0 = no pain , 1 = mild pain , 2 = moderate pain , and 3 = severe pain , and visual analog scale of 0–10 , where 0 = no pain and 10 = worst imaginable pain . A significant reduction in the incidence of pain was observed in the Valsalva group : 18 of 25 ( 72 % ) patients , whereas 25 of 25 ( 100 % ) experienced pain in the other two groups ( P < 0.001 ) . A significant reduction in the severity of pain , number of patients in whom one needed to make the vein prominent before cannulation , and the time taken for the same were observed in the Valsalva group ( P < 0.001 ) BACKGROUND Various external factors can influence patients ' experiences of noxious stimuli , but little is known of how patients ' natural behaviour may be relevant . We ascertained how often patients spontaneously look or look away during  venepuncture  and associated reports of pain during a previously reported experimental r and omized study . The study was conducted in the outpatient department of a U.K. district general hospital . METHODS Patients were r and omized to hearing ' sharp scratch ' or the verbal cue ' ready ? ' immediately before venepuncture .  Whether patients looked or looked away during needle insertion was recorded . Patients were asked to rate their pain using a verbal numerical rating score ( VNRS ) and verbal response scale ( VRS ) . RESULTS One hundred ninety-two patients were included ; mean age 51.7 years , 55 % male . During needle insertion , 73 % spontaneously looked away , whereas 27 % looked . There was no significant difference in the proportion of these patients assigned to the ' sharp scratch ' or ' ready ? ' groups , nor was there any difference in mean age or gender . For the group that looked , mean VNRS was 0.48 and VRS was 1.27 , significantly less than the group that looked away ( mean VNRS 0.94 , p = 0.014 ; VRS 1.61 , p = 0.002 ) . As previously reported , pain ratings between ' sharp scratch ' and ' ready ? ' groups were not significantly different . CONCLUSIONS Almost three quarters of patients spontaneously look away during venepuncture , but their pain ratings are almost twice that of the quarter of patients who look . It is unclear why this may be , but previous experimental studies indicate that observing the body when a noxious stimulus is applied can have an analgesic effect Objective : Venous blood sampling is one of the most common diagnostic medical procedures performed in clinical practice . It has been shown that negatively loaded words may result in negative affective reactions and , consequently , in an increased perception of pain . We aim ed to evaluate whether common warnings before venous blood sampling might induce unnecessary pain . Methods : We included 100 healthy participants ( 50 females , 50 males ) who were r and omized to one of the 2 study groups ( “ sting ” vs. “ beware ” ) . Directly before insertion of the needle , the participants were warned with either the word “ sting ” or “ beware . ” Venous blood sampling was performed according to a st and ardized protocol . Preinterventional and postinterventional blood pressure and heart rate , as well as pain scores after venous blood sampling , were evaluated . Results : There were 98 participants , 26.2±3.2 years of age , who were included into the analysis . Participants experienced significantly more pain after having been warned with the word “ sting ” compared with the word “ beware . ” The numeric rating scale results were 2.7±1.2 versus 1.9±1.1 , respectively ( P=0.001 ) . Discussion : Words associated with pain increase the perception of pain during venous blood sampling . Omitting these words may be a simple and essential method by which to avoid unnecessary pain We tested the effectiveness of the cough trick ( CT ) as a method of pain relief during peripheral venipuncture ( VP ) in a crossover study . Twenty healthy volunteers were punctured twice in the same h and vein within an interval of 3 wk , once with the CT procedure and once without it . The intensity of pain , h and withdrawal , palm sweating , blood pressure , heart rate , and serum glucose concentration were recorded . The intensity of pain during VP with the CT procedure was less than without it , whereas the other variables changed insignificantly . The easily performed CT was effective in pain reduction during VP , although the mechanism remains unclear This study examined the impact of threatening information on coping and pain tolerance in a healthy adult sample . Prior to engaging in a Cold Pressor Test ( CPT ) , 121 college students were r and omly assigned to one of three conditions : a threat condition in which they read an orienting passage warning them about symptoms and consequences of frostbite ( pain as a signal for nociception ) , a reassurance condition in which they read an orienting passage about the safety of the CPT ( pain independent of nociception ) , or a control condition in which no orienting passage was read before the experimental task . Only 15.6 % of participants in the threat group completed the CPT to its 4-minute duration , compared with 55.6 % in the reassurance group and 45.2 % of those in the control group . Even though groups did not differ on level of reported pain , threatened participants catastrophized more about the pain and reported less use of cognitive coping strategies ( reinterpreting pain sensations , ignoring pain , diverting attention away from pain to other experiences , and using coping self-statements ) than other respondents . A path analysis indicated that the relation between threat and pain tolerance was fully mediated by catastrophizing and cognitive coping . Together , findings suggest that pain appraised as threatening contributes to a specific pattern of coping responses associated with a reduced capacity to bear pain Background and objective : Stimulating the vagus nerve reduces pain . The purpose of this study was to evaluate the effect of a Valsalva manoeuvre , which stimulates the vagus nerve , on perception of pain during peripheral venous cannulation in adult patients . Methods : This was a prospect i ve r and omized clinical trial . One hundred and ten patients scheduled for elective surgery were r and omly divided into two groups . Half of the patients , Group A , underwent venepuncture during a Valsalva manoeuvre and the other half of the patients , Group B , underwent venepuncture without performing a Valsalva manoeuvre . Patients made a pain assessment using a 0–10 point numerical rating scale . Results : The numerical rating scale score was 1.5 ± 1.2 for Group A and 3.1 ± 1.9 for Group B , the difference being statistically significant ( P < 0.0001 ) . Conclusions : On the basis of data from this study , the Valsalva manoeuvre may be of the value before venous cannulation as a simple and practical method to reduce pain from venous cannulation OBJECTIVES Health care providers frequently issue a verbal warning before venipuncture . Communications that induce negative expectations in patients can lead to the " nocebo " response , defined as experiencing greater pain . But is this also true for " sharp scratch " ? METHODS The study was conducted across 4 U.K. hospitals . Two separate surveys of health care providers and patients explored the prevalence , phraseology , rationale , and reaction to verbal warnings before venipuncture .  Blinded adult patients already attending an outpatient department during a 2-week period were r and omized to hearing a " sharp scratch " or the verbal cue " ready ? " immediately before venipuncture . They were also asked to rate their pain ( the primary outcome ) . RESULTS 77 % of 117 health care providers surveyed issued a verbal warning before venipuncture ; 73 % used " sharp scratch " . Of 62 patients surveyed , 56 % agreed that " sharp scratch " accurately describes venipuncture , and 64 % agreed that they prefer " sharp scratch " to no warning . With increasing age , a preference came for an alternative warning to " sharp scratch " ( P = 0.039 ) and to be distracted by conversation ( P = 0.002 ) . Of 192 patients in the r and omized study , there was no difference in pain between the " sharp scratch " and " ready " groups . The numeric rating scores were 0.74 SD 1.06 vs. 0.88 SD 1.18 , respectively . ( P = 0.493 ) . CONCLUSIONS Most health care providers use the verbal warning " sharp scratch " before venipuncture . Most patients find this acceptable and prefer it to no warning . An exception may be elderly patients , who may prefer to be distracted by conversation . " Sharp scratch " makes no difference to the pain experienced compared with a verbal cue Although immunization injections are the most common painful medical procedures , pain-relieving interventions are not routinely used . In this r and omized controlled trial , we compared the effectiveness of topical anesthesia using liposomal lidocaine to : ( 1 ) vapocoolant spray using a proprietary blend of 1,1,1,3,3-pentafluoropropane and 1,1,1,2-tetrafluoroethane ; ( 2 ) nurse-administered tactile stimulation ; or ( 3 ) self-directed distraction by means of reading a magazine . Liposomal lidocaine was more effective ( p < or=0.05 ) than distraction , as assessed by self-reported pain using the visual analog scale and global report , but did not differ from either vapocoolant spray or tactile stimulation . This information can be incorporated in immunization programs OBJECTIVE To examine the effect of listening to self-selected music versus an intradermal injection of normal saline solution on the intensity and distress of intravenous ( IV ) catheter insertion pain .  DESIGN Prospect i ve , r and omized , controlled study . SETTING Inpatient and outpatient units in 2 university-affiliated southwestern medical centers . PATIENTS One hundred ten adult in patients and out patients undergoing IV therapy .  OUTCOME MEASURES Pain intensity , pain distress , and IV insertion difficulty visual analog scales . INTERVENTION Patients were r and omly assigned to receive an intradermal injection of normal saline solution , listen with headphones to self-selected music , or be in a control group for IV insertion . RESULTS A MANOVA revealed no statistically significant multivariate or univariate differences in pain by treatment group , but significantly higher pain distress scores with failed IV insertions . The pain intensity and distress scores were significantly higher in the saline solution group when compared with the music and control groups combined . Insertion difficulty was significantly positively correlated with pain intensity and distress for the entire sample , with weak , nonsignificant correlations in the music group . CONCLUSION Intradermal unpreserved saline solution contributes to greater pain intensity and distress , greater insertion difficulty , and a higher failure rate than the use of music or routine IV insertion . Listening to preferred music attenuates the effect of insertion difficulty on IV insertion pain . Intravenous insertion attempts were unsuccessful in more than one third of the subjects , result ing in higher pain distress scores . Further research is needed on interventions to reduce IV insertion pain and on factors contributing to IV insertion failure Distraction is an intuitive way of coping with pain and is often used in children 's pain treatment programs . However , empirical evidence concerning the effectiveness of distraction is equivocal . One potential explanation might be that distraction does not work for everyone in every situation . In the current series of studies , we examined the role of pain catastrophizing as an influencing factor of distraction effectiveness . In the first study , we investigated the use of pain coping strategies ( including distraction ) in schoolchildren ( N = 828 , aged 8 - 18 years ) by means of a question naire . Results indicated that children with higher levels of pain catastrophizing reported using less  distraction strategies in daily life than children with lower levels of pain catastrophizing . In the second study , a sub sample ( N = 81 , aged 9 - 18 years ) performed a painful cold pressor task ( CPT ) ( 12 ° C ) . Participants were r and omly assigned to a distraction group , in which an attention-dem and ing tone-detection task was performed during the CPT , or a control group , in which no distraction task was performed . Results showed that participants in the distraction group were engaged in the distraction task , and reported to have paid less attention to pain than participants in the control group . However , distraction was ineffective in reducing cold pressor pain , and even intensified the pain experience in high catastrophizing children . Caution may be warranted in using distraction as a ' one size fits all ' method , especially in high catastrophizing children OBJECTIVES Two experiments compared the effects of different distraction tasks on  pain .  Based on multiple-re source theory , Expt 1 predicted that the more a distractor shares processing re sources with pain perception the greater the interference between the two . Experiment 2 tested whether the emotional content of the distractor would differentially effect measures that are supposedly reflective of the affective component of pain . DESIGN Both experiments used repeated measures design s , with counterbalanced distraction conditions . METHODS In Expt 1 20 participants indicated their pain threshold . No instructions , or one of three distraction conditions were presented across four blocks of potassium iontophoresis . The distractors were : thermal and light detection , and neutral imagining . In Expt 2 30 participants had three blocks of pain threshold , pain tolerance , and pain rating trials . For threshold , tolerance , and rating trials , one block was without distraction , a second block was completed during light detection , and a third block while imagining an enjoyable holiday . RESULTS In Expt 1 all the distractors increased pain threshold . The two detection tasks were similarly effective , and more so than the imagination task . Performance on the two detection tasks was impaired by painful stimulation similarly for both tasks . In Expt 2 the visual detection distractor increased pain threshold and tolerance and reduced pain ratings while pleasant imagery only increased pain threshold . CONCLUSIONS These results indicate that a task that requires attention to external cues has more impact on pain than either a positive or neutral imagination task . However , it is not clear that the specific re sources used by the distraction tasks moderated pain differentially as predicted by multiple-re source theory INSERTION OF AN IV CATHETER is a commonly performed and painful procedure . The use of cognitive-behavioral interventions ( CBIs ) may decrease pain by diverting the patient 's attention to stimuli other than pain . THIS R AND OMIZED , CONTROLLED TRIAL examined the effect of three CBIs -- music , kaleidoscope , and guided imagery -- on IV insertion pain in 324 patients . NO STATISTICALLY SIGNIFICANT differences in IV insertion pain were found among the treatment and control groups or between choosing versus being assigned a CBI . Insertion attempts were more difficult in women , and insertion difficulty was correlated with pain intensity and pain distress . Pain intensity was related to insertion site and catheter gauge Abstract Objective : This study examined the effect of brief functional relaxation ( FR ) training on needle anxiety ( NA ) during vaccinations . Participants : From October 2010 through May 2012 , 48 undergraduates were recruited through the psychology research participant pool . Methods : Students ( N = 48 ) were r and omly assigned to a 15-minute brief FR session delivered via MP3 player or a st and ard care condition ( 15 minutes of sitting quietly ) prior to receiving injections at the immunization clinic . Measures were completed before ( T1 ) and after ( T2 ) the assigned condition , assessing expected NA , state anxiety , blood pressure , and heart rate ; and after the injection ( T3 ) , self-reported NA during the injection . Results : Unexpectedly , the groups did not differ at T2 . However , during the injection , brief FR participants indicated lower self-reported NA ( T3 ) than st and ard care . Conclusions : Brief FR is a simple , inexpensive technique that may reduce NA in college health setting s and help decrease delays in treatment seeking BACKGROUND : Venous cannulation is often performed without any analgesia , even though pain experienced during this procedure is at times very distressing . Various pharmacological and nonpharmacological measures have been tried with variable results to minimize venous cannulation pain . We design ed the present study to evaluate the efficacy of a flash of light on attenuating venous cannulation pain . METHODS : Ninety adults ( 15–60 yr ) , ASA physical status I and II , of either sex , undergoing elective laparoscopic cholecystectomy , were included in this prospect i ve and r and omized study . Patients were divided into three groups of 30 each . Group I ( control ) ; Group II ( distraction ) : photographed without a flash of light ; and Group III ( flash ) : photographed with a flash of light just before venous cannulation of a vein on the dorsum of the nondominant h and . Immediately after the photograph , venous cannulation was performed using an 18-gauge cannula . RESULTS : Two patients from each group could not be cannulated on their first attempt and were therefore dropped from subsequent analysis . The incidence of venous cannulation pain in the flash group was lower , i.e. , 50 % ( 14 of 28 ) when compared to 100 % ( 28 of 28 ) observed in the other two study groups ( P < 0.01 ) . Severity of venous cannulation pain as assessed by the Visual Analog Scale scores ( between 0 and 100 ; where 0 = no pain and 100 = worst imaginable pain ) presented as median ( interquartile range ) were reduced in the flash [ 10(20 ) ] and distraction [ 20(10 ) ] groups compared with the control group [ 40(20 ) ] ( P < 0.01 ) . The severity of venous cannulation pain was also reduced in the flash group compared with the distraction group ( P < 0.01 ) . CONCLUSION : We conclude that a flash of light before venous cannulation is a safe , effective , and easy-to-use method for minimizing venous cannulation pain
BACKGROUND This systematic review evaluated the effectiveness of simple psychological interventions for managing pain and fear  in adults undergoing vaccination or related common needle procedures ( ie , venipuncture/venous cannulation ) .