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Simple Psychological Interventions for Reducing Pain From Common Needle Procedures in Adults: Systematic Review of Randomized and Quasi-Randomized Controlled Trials

Boerner, Katelynn E. BSc (Hons)*,†; Birnie, Kathryn A. BA (Hons)*,†; Chambers, Christine T. PhD, R Psych†,‡; Taddio, Anna BScPhm, MSc, PhD§,∥; McMurtry, C. Meghan PhD, C Psych¶,#,**; Noel, Melanie PhD††; Shah, Vibhuti MD, MSc‡‡,§§; Pillai Riddell, Rebecca PhD, C Psych∥∥HELPinKids&Adults Team

doi: 10.1097/AJP.0000000000000270
Adult Psychological Interventions

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).

Design/Methods: Databases were searched to identify relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear were prioritized as critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk (RR) with 95% confidence intervals (CI).

Results: No studies involving vaccination met inclusion criteria; evidence was drawn from 8 studies of other common needle procedures (eg, venous cannulation, venipuncture) in adults. Two trials evaluating the impact of neutral signaling of the impending procedure (eg, “ready?”) as compared with signaling of impending pain (eg, “sharp scratch”) demonstrated lower pain when signaled about the procedure (n=199): SMD=−0.97 (95% CI, −1.26, −0.68), after removal of 1 trial where self-reported pain was significantly lower than the other 2 included trials. Two trials evaluated music distraction (n=156) and demonstrated no difference in pain: SMD=0.10 (95% CI, −0.48, 0.27), or fear: SMD=−0.25 (95% CI, −0.61, 0.10). Two trials evaluated visual distraction and demonstrated no difference in pain (n=177): SMD=−0.57 (95% CI, −1.82, 0.68), or fear (n=81): SMD=−0.05 (95% CI, −0.50, 0.40). Two trials evaluating breathing interventions found less pain in intervention groups (n=138): SMD=−0.82 (95% CI, −1.21, −0.43). The quality of evidence across all trials was very low.

Conclusions: There are no published studies of simple psychological interventions for vaccination pain in adults. There is some evidence of a benefit from other needle procedures for breathing strategies and neutral signaling of the start of the procedure. There is no evidence for use of music or visual distraction.

Supplemental Digital Content is available in the text.

*Departments of Psychology and Neuroscience, IWK Health Centre

Pediatrics and Psychology & Neuroscience, Dalhousie University

Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS

§Leslie Dan Faculty of Pharmacy

§§Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto

The Hospital for Sick Children

∥∥York University, Toronto

Department of Psychology, University of Guelph, Guelph

#Children’s Health Research Institute

**Department of Paediatrics, University of Western Ontario, London, ON

††Department of Psychology, University of Calgary, AB, Canada

‡‡Mount Sinai Hospital, Toronto, ON

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

HELPinKids&Adults (Help ELiminate Pain in Kids and Adults) Team: MacDonald N. E., Rogers J., Bucci L., Mousmanis P., Lang E., Halperin S. A., Bowles S., Halpert C., Ipp M., Asmundson G. J. G., Rieder M., Robson K., Uleryk E., Antony M. M., Dubey V., Hanrahan A., Lockett D., Scott J., Votta Bleeker E.

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. K.E.B. was supported by a doctoral award from the Canadian Institutes of Health Research, Ottawa, ON, Canada during the completion of this project. K.A.B. was supported by a Vanier Canada Graduate Scholarship. C.T.C. was funded by a Canada Research Chair and by the CIHR during the completion of this work. K.E.B., K.A.B., and M.N. are trainee members of Pain in Child Health (PICH): a strategic training initiative funded by CIHR. A.T. declares a grant from Pfizer, and study supplies from Natus and Ferndale. C.T.C. 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.

Reprints: Christine T. Chambers, PhD, R Psych, Centre for Pediatric Pain Research (West), K8536, IWK Health Centre, 5850/5980 University Avenue, Halifax, NS B3K 6R8 (e-mail:

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Received April 11, 2015

Accepted June 9, 2015

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