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Clin J Pain. 2015 Oct;31(10 Suppl):S3-11. doi: 10.1097/AJP.0000000000000272.

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

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*Department of Psychology, University of Guelph, Guelph †Children's Health Research Institute ‡Department of Paediatrics, Western University, London §Department of Psychology, York University ∥The Hospital for Sick Children ¶Department of Psychiatry #Leslie Dan Faculty of Pharmacy ¶¶Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto ∥∥Mount Sinai Hospital, Toronto, ON **Department of Psychology, University of Regina, Regina, SK ‡‡Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University §§Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada ††Department of Psychology, University of Calgary, AB, Canada.



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.


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.


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.


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.

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