Technically Speaking: Tools for Addressing Pain and Fear of Needles During Vaccinations

What percent of children do you estimate has such a severe fear of pain or needles that it becomes an obstacle to vaccination?

If you estimated 10% to 20%, you would be close. A recent systematic literature review (Taddio A, McMurtry CM, Logeman C, et al. Prevalence of pain and fear as barriers to vaccination in children - Systematic review and meta-analysis. Vaccine. 2022 Dec 12;40(52):7526-7537) suggested that the prevalence of pain or needle fear as an obstacle to vaccination was:

• 8% among children up to 18 years of age in the general population
• 18.3% among under-vaccinated children in this age range

The authors of the review concluded, “Pain from injection or fear of needles were demonstrated to be sufficiently prevalent as barriers to vaccination in children to warrant attention.”

Knowing this, do you think that if clinicians worked with families to improve the vaccination experience, we could improve vaccination rates? Would this, at least, contribute to improved trust of clinicians and the medical setting?

Two new 1-hour webinars, both available on the Immunize.org homepage, address the topic of how to improve the vaccination experience.

Improving the Vaccination Experience: Accessible Vaccination for Neurodiverse People at Any Age

First aired on December 13, 2022, this webinar featured two experts from the Autism Society, Danielle Hall, MSW; Program Manager, Vaccine Education Initiative, and Allie Tasche, BEd, MSLOD; Director of National Programs.

Along with Kelly L. Moore, MD, MPH, President and CEO of Immunize.org, the Autism Society experts discussed practical tips to improve vaccine confidence by employing effective strategies to reduce stress when vaccinating neurodiverse patients. This is particularly important because people with autism and other developmental disabilities have lower childhood immunization rates than their peers without autism, leaving them vulnerable to many vaccine-preventable diseases. Vaccination visits can be especially stressful not only for the patient, but also for caregivers, family members, and even office staff.

A few of the strategies offered to reduce pain and anxiety at vaccination visits for neurodiverse patients included:

• Use of a visual schedule. As the name implies, a visual schedule uses pictures or icons to show a step-by-step timeline of what to expect during the visit. For an example, see the Autism Society’s “Getting the COVID-19 Vaccine” visual schedule.
• Use of injection tools. The speakers described two popular injection tools used in their “Vaccine Education Initiative” clinics:
  • “Buzzy Bee,” a device that delivers high-frequency, low-amplitude vibration and cold to diminish the sense of pain
  • “Shot Blocker,” a palm-sized, inexpensive plastic disc with contact points on the underside that saturate the sensory nerves to distract the patient from the pain signals caused by the injection
• Use of distraction. The webinar highlighted a wide range of distraction techniques (e.g., music, videos, fidgets) that many families already have handy. By having the patient absorbed in a favorite distractor during vaccinations, they are less focused on the injection and associated pain.

Improving the Vaccination Experience: Reducing Pain and Anxiety for Children and Adults

With well over 2,000 people registered, the second webinar, aired on February 28, 2023, as Dr. Kelly Moore hosted experts from the Canadian group, HELP Eliminate Pain in Kids and Adults:

• Anna Taddio, BScPhm, PhD; Professor, Faculty of Pharmacy, University of Toronto; Senior Associate Scientist, The Hospital for Sick Children (SickKids), Toronto, Ontario
• Lucie Marisa Bucci, MA; Director, Policy and Government Relations, Society for Infodemic Management (SIM), Québec, Québec

In this webinar, Dr. Taddio emphasized that anxiety about needles and injections affects as many as 2 out of 3 children and 1 out of 4 adults, and that this anxiety can contribute to dreading, delaying, or avoiding vaccinations, even when the importance of preventing illness is understood. The principles behind vaccination pain and anxiety, and simple, evidence-based strategies to reduce apprehension were discussed. Notably, Dr. Taddio’s research on these topics was used by the World Health Organization (WHO), Public Health Canada, and others to develop guidelines for reducing vaccination pain.

Her team has translated the research into safe, effective, and practical steps that vaccinators, vaccine recipients, and caregivers can take to reduce vaccination-related pain and anxiety. Using the acronym “CARD,” the team describes the four components of the system in this way:

• Comfort strategies include providing educational materials, so people know what to expect and interventions that encourage serenity and physical ease.
• Asking questions can help everyone to learn more about the vaccine and what to expect.
• Relax strategies help keep people calm. Immunizers can provide private spaces for vaccination, reduce visual cues that elicit fear (such as needles) and minimize excessive noise and activity to promote calmness.
• Distract strategies are used to take an individual’s mind off the needle injection. Immunizers can ask individuals about their preferences.

In sum

People have many reasons for missing vaccinations. Addressing pain is one way that your practice may be able to make a noticeable difference in vaccine acceptance while also reinforcing the trust your patients and families have in you and your team. If you did not have a chance to watch the two webinars described herein, they offer a variety of tips for getting started. As noted above, you can find links to the webinars from Immunize.org’s homepage. Once on each webinar’s landing page, you will find the archived recording as well as a PDF of the slides and links to key web resources from the guests’ organizations. Get yourself and your team started today!