Procedural and physical interventions for vaccine injections systematic review of randomized controlled trials and quasi-randomized controlled trials

Anna Taddio, Vibhuti Shah, C. Meghan McMurtry, Noni E. MacDonald, Moshe Ipp, Rebecca Pillai Riddell, Melanie Noel, Christine T. Chambers

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Abstract

Background: This systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination. Design/Methods: Databases were searched using a broad search strategy to identify relevant randomized and quasi-randomized 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): standardized 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 methodologically 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 populations 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.

Original languageEnglish
Pages (from-to)S20-S37
JournalClinical Journal of Pain
Volume31
Issue number10
DOIs
Publication statusPublished - Oct 2015

Bibliographical note

Publisher Copyright:
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

ASJC Scopus Subject Areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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Taddio, A., Shah, V., McMurtry, C. M., MacDonald, N. E., Ipp, M., Riddell, R. P., Noel, M., & Chambers, C. T. (2015). Procedural and physical interventions for vaccine injections systematic review of randomized controlled trials and quasi-randomized controlled trials. Clinical Journal of Pain, 31(10), S20-S37. https://doi.org/10.1097/AJP.0000000000000264