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New guidelines aim to reduce vaccine injection pain
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New guidelines published in CMAJ propose recommendations for all health care workers to employ to minimize the amount of pain induced by vaccines, in both children and adults.
“Noncompliance with vaccination compromises the individual and community benefits of immunization by contributing to outbreaks of vaccine preventable diseases,” Anna Taddio MSc, PhD, of the department of child health evaluative sciences at the Hospital for Sick Children, Toronto, Canada, and colleagues wrote. “This guideline provides recommendations for interventions that can mitigate vaccination pain.”
The guideline authors included 25 health care professionals with expertise in vaccine administration, psychology and pain management. The authors researched evidence based articles relevant to vaccine pain. Recommendations were considered based on four developmental stages, children aged younger than 3 years, children aged 3 to 12 years, adolescents aged 12 to 17 years and adults aged older than 17 years.
The key pain reduction recommendations for physicians administering vaccines to patients aged older than 3 years include:
- avoiding aspiration during intramuscular injections;
- administering the most painful vaccine last in cases of multiple vaccinations;
- having the patient sit upright during vaccination; and
- seeking education in vaccine pain reduction.
Additionally, the guidelines suggest further recommendations for physicians administering vaccines, which apply only to children, including:
- having the mother breastfeed children aged younger than 2 years during vaccination;
- holding children aged younger than 3 years during vaccination;
- application of topical pain analgesics for children aged younger than 12 years;
- having a parent present during vaccination; and
- educating parents about pain management before vaccination.
The guideline authors noted that no single intervention will completely eliminate pain from the process of vaccination; however, they advised combining individual interventions to achieve the maximum amount of pain reduction. The researchers also emphasized that many of the interventions suggested can be implemented with little or no cost, providing physicians with interventions that are practical and accessible in all vaccination settings.
“Many of these recommendations can be used in a variety of settings where vaccines are delivered, whether in a physician's office, a public health setting such as a school or a workplace,” Taddio and colleagues wrote. – by David Costill
Disclosure: Taddio reports receiving a grant from Pfizer, and study supplies from Natus and Ferndale. Please see the study for a full list of all other researchers’ relevant financial disclosures.
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