Effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections: a systematic review and meta-analysis.
Journal
JBI evidence synthesis
ISSN: 2689-8381
Titre abrégé: JBI Evid Synth
Pays: United States
ID NLM: 101764819
Informations de publication
Date de publication:
01 02 2023
01 02 2023
Historique:
pubmed:
10
2
2023
medline:
14
2
2023
entrez:
9
2
2023
Statut:
epublish
Résumé
The objective of this review was to synthesize the best available research evidence regarding the effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections. Pain associated with intramuscular injections continues to be a challenge for nurses. Various physical stimulation methods to alleviate pain and improve satisfaction for patients receiving intramuscular injections have been reported; however, the evidence surrounding the effectiveness of these methods remains inconclusive. This systematic review considered randomized and quasi-experimental studies that used any physical stimulation strategies (eg, skin tapping, manual pressure, massage, pinch, traction) for adults aged 18 years and over receiving intramuscular injections. Studies that evaluated pain using validated instruments were considered for inclusion. A three-step search strategy was conducted. MEDLINE, Embase, CINAHL, the Cochrane Library (Cochrane CENTRAL), Google Scholar, Dissertation Abstracts International, ProQuest Dissertations and Theses, and MedNar were searched from inception until 2020. We restricted the inclusion of studies to trials published in English. Two independent reviewers conducted the critical appraisal of eligible studies using the JBI checklists for randomized controlled and quasi-experimental trials. Data were extracted using the JBI data extraction tool, and meta-analysis and subgroup analysis were undertaken, where appropriate. Twenty-five studies were included with a total sample size of 1956 patients. Pooled results demonstrated that pain was significantly less with the use of the Helfer skin tap technique compared to no intervention (two studies; RR 0.73; 95% CI 0.66, 0.81; P <0.00001) or standard intervention (three studies; SMD -2.25; 95% CI -3.65, -0.85; P =0.002). Intervention with acupressure using standard treatment as control showed significant reduction in pain intensity (MD -4.78; 95% CI -5.32, -4.24; P <0.00001). Similarly, pain was significantly lower with manual pressure (two studies; SMD -0.42; 95% CI -0.69, 0.15; P =0.002) when compared to standard treatment. Pain scores were significantly lower in patients who received pinch technique, ShotBlocker, massage, or combination intervention (skin traction, pressure, and rapid muscle release) compared with no intervention, standard treatment, or placebo control. The evidence from this review demonstrates that physical stimulation - particularly the Helfer skin tap technique, acupressure, manual pressure, pinch technique, ShotBlocker, massage, and combination - can significantly lower intramuscular injection pain; however, this is based on low or very low certainty of evidence. PROSPERO CRD42020168586.
Identifiants
pubmed: 36758552
doi: 10.11124/JBIES-20-00590
pii: 02174543-202302000-00004
doi:
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
373-400Informations de copyright
Copyright © 2023 JBI.
Déclaration de conflit d'intérêts
The other authors declare no conflict of interest.
Références
Hopkins U, Arias C. Large-volume IM injections: a review of best practices. Oncol Nurse Advis 2013;4(1):32–37.
Kara D, Uzelli D, Karaman D. Using ventrogluteal site in intramuscular injections is a priority or an alternative? Int J Caring Sci 2015;8(2):507–513.
Zeydi AE, Khezri HD. Can lidocaine be safely used to reduce pain caused by intramuscular penicillin injections? A short literature review. Oman Med J 2012;27(4):337.
World Health Organization Injection safety fact sheet, factsheet no 231 [internet]. Geneva: World Health Organization; 2019 [cited 2019 Sep 30]. Available from: https://www.who.int/teams/integrated-health-services/infection-prevention-control/injection-safety .
Kanika, Rani HK, Prasad S. Effect of massage on pain perception after administration of intramuscular injection among adult patients. Nurs Midwifery Res J 2011;7(3):130–138.
Wynaden D, Landsborough I, Chapman R, McGowan S, Lapsley J, Finn M. Establishing best practice guidelines for administration of intramuscular injections in the adult: a systematic review of the literature. Contemp Nurse 2005;20(2):267–277.
Malkin B. Are techniques used for intramuscular injection based on research evidence? Nurs Times 2008;104(50-51):48–51.
Farhadi A, Esmailzadeh M. Effect of local cold on intensity of pain due to Penicillin Benzathin intramuscular injection. Int J Med Med Sci 2011;3(11):343–346.
Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965;150:(3699)971-78.
Huttner JJ, inventor; Bionix Development Corporation, assignee. Method for controlling the pain from injections or minor surgical procedures and apparatus for use therewith. United States Patent 6902554. 2005 June 7.
Washburn M, Eleanor J. Gate control theory and its application in a physical intervention to reduce children’s pain during immunization injections [thesis]. Georgia State University, 2007 [cited 2019 Aug 02]. Available from: https://scholarworks.gsu.edu/psych_theses/38/ .
Helfer J. Painless injections: Helfer skin tap technique. Nurse Educator 2000;25(6):272–273.
Barnhill BJ, Holbert MD, Jackson NM, Erickson RS. Using pressure to decrease the pain of intramuscular injections. J Pain Symptom Manage 1996;12(1):52–58.
Celik N, Khorshid L. The use of shot blocker for reducing the pain and anxiety associated with intramuscular injection: a randomized, placebo controlled study. Holist Nurs Pract 2015;29:261–271.
Kara D, Yapucu Güneş U. The effect on pain of three different methods of intramuscular injection: a randomized controlled trial. Int J Nurs Pract 2016;22(2):152–159.
Najafi DS, Mohebi NZ, Malekzadeh J. Comparing the pain severity caused by muscular injection of Tramadole in Z and Bulb methods. Armaghane Danesh 2008;12(4):101–108.
Oztürk D, Baykara ZG, Karadag A, Eyikara E. The effect of the application of manual pressure before the administration of intramuscular injections on students’ perceptions of post injection pain: a semi-experimental study. J Clin Nurs 2017;26(11-12):1632–1638.
Sparks L. Taking the “ouch” out of injections for children: using distraction to decrease pain. Am J Matern Child Nurs 2001;26(2):72–78.
Yeganekhah MR, Abedini Z, Dadkhah Tehrani T. Evaluation of an applied method in reducing the pain of intramuscular injection. Qom Univ Med Sci J 2013;7(2):1–6.
Yilmaz D, Khorshid L, Dedeoglu Y. The effect of the Z-Track Technique on pain and drug leakage in intramuscular injections. Clin Nurse Spec 2016;30(6):E7–12.
Alavi NM. Effectiveness of acupressure to reduce pain in intramuscular injections. Acute Pain 2007;9(4):201–205.
Kant E, Akpinar RB. The effect of music and the pressure applied on pain induced by intramuscular injection. Int J Caring Sci 2017;10(3):1313–1318.
Hogan M-E, Kikuta A, Taddio A. A systematic review of measures for reducing injection pain during adult immunization. Vaccine 2010;28(6):1514–1521.
Ueki S, Yamagami Y, Makimoto K. Effectiveness of vibratory stimulation on needle-related procedural pain in children: a systematic review. JBI Database System Rev Implement Rep 2019;17(7):1428–1463.
Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L Aromataris E, Munn Z. Chapter 3: Systematic reviews of effectiveness. JBI Manual for Evidence Synthesis [internet]. Adelaide: JBI; 2017 [cited 2019 Aug 2]. Available from: https://synthesismanual.jbi.global .
CMC S, Vargese SS, Kurian N, Cherian SA, Mathew E, Fernandez R, et al. Effectiveness of physical stimulation on injection pain in adults receiving intramuscular injections. PROSPERO 2020 [cited 2020 Sep 30]. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020168586 .
Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA Chapter 8: Assessing risk of bias in a randomized trial. Cochrane handbook for systematic reviews of interventions version 6. 1 (updated September 2020). Cochrane; 2020 [cited 2019 Aug 2]. Available from: https://training.cochrane.org/handbook .
Serena S. Rhythmic skin tapping: an effective measure to reduce procedural pain during IM injection. Nurs J India 2010;101(8):178–180.
Elbourne DR, Altman DG, Higgins JP, Curtin F, Worthington HV, Vail A. Meta-analyses involving cross-over trials: methodological issues. Int J Epidemiol 2002;31(1):140–149.
Deeks JJ, Higgins JP, Altman DG. Analysing data and undertaking meta-analyses. In: Cochrane handbook for systematic reviews of interventions [internet]. John Wiley, Sons, Ltd, 2008 [cited 2020 Nov 29]. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/9780470712184.ch9 .
Schünemann H, Brozek J, Guyatt G, Oxman A, editors. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013 [cited 2020 Nov 23]. Available from: https://gdt.gradepro.org/app/handbook/handbook.html .
Moher D, Liberati A, Tetzlaff J, Altman DG; The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6(7):e1000097.
Menaka J. A study to assess the effectiveness of Helfer skin tap technique on pain reduction among infants undergoing intramuscular vaccination in tertiary care setting [thesis]. Coimbatore: PSG College of Nursing; 2018.
Sivapriya S, Kumari L. A study to assess the effectiveness of Helfer skin tap technique on pain during intramuscular injection among neonates born in labour room of a selected tertiary level hospital, UP. Int J Sci Res 2015;4(4):547–552.
Jose RM, Sulochana B, Shetty S. Effectiveness of skin tap technique in reducing pain response. Int J Nurs Educ Scholarsh 2012;4(1):56–57.
Ay S, Evcik D, Tur BS. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol 2010;29(1):19–23.
Lakhani R, Chacko M, Ghatge S, Jadhav S, Soumya MK, Patkar S, et al. The Intensity of pain experienced by respondents given intramuscular (IM) injection with/without skin tapping technique [internet]. Sigma Repository; 2014 [cited 2019 Aug 2]. Available from: https://sigma.nursingrepository.org/handle/10755/312899 .
Soliman HMM, Hassnein AA. Efficacy of Helfer skin tapping technique on pain intensity as perceived by the patients receiving intramuscular injection. Int J Nurs Didactics 2016;6(2):12-.
Cherian AT. Effectiveness of rhythmic skin tapping on pain during intramuscular (IM) injection among male adults in a selected hospital at Mangalore. Int J Nur Educ Res 2017;5(1):91–98.
Jyoti G, Arora S, Sharma B. Helfer skin tap technique for the IM injection pain among adult patients. Nurs Midwifery Res J 2018;14(3):18–30.
Shah S, Narayanan A. Effect of Helfer rhythmic skin tap technique on procedural pain among patients receiving intramuscular injection. Manipal J Nurs Health Sci 2016;2(1):3–9.
Raddadi Y, Adib-Hajbaghery M, Ghadirzadeh Z, Kheirkhah D. Comparing the effects of acupressure at LI4 and BL32 points on intramuscular injection pain. Eur J Integr Med 2017;11:63–68.
Chung JW, Ng WM, Wong TK. An experimental study on the use of manual pressure to reduce pain in intramuscular injections. J Clin Nurs 2002;11(4):457–461.
Locsin R. The effects of the “pinch-grasp” technique on pain reaction of selected clients during intramuscular injection. ANPHI papers 1983;18:3–8.
Mahato E, Thakur I. Effectiveness of Helfer’s skin tap technique versus routine technique on pain reduction among patient’s receiving intramuscular injections. Int J Nurs Educ 2019;11(1):41–44.
Therese A, Devi S. Effectiveness of Helfer skin tap technique and routine technique on pain reduction among patients receiving intramuscular injection at Government General Hospital, Puducherry. Int J Sci Res 2014;3(10):1446–1449.
Fletcher H. Painless Depo-medroxyprogesterone acetate (DMPA) injections using the ‘pinch technique’. J Obstet Gynaecol 2004;24(5):562–563.
Neupane U, Thomas PL, Thakur R. A study to assess the effectiveness of Helfer skin tap technique on the level of pain during intramuscular injection among adults in a selected hospital, Bangalore. Int J Health Sci Res 2019;9(1):95–103.
Suhrabi Z, Taghinejad H. Effect of acupressure (UB32) on pain intensity in intramuscular injections. Iran J Nurs Midwifery Res 2014;19(1):24–27.
Vathani G, Kumari MJ, Pandit VR. Effectiveness of Helfer skin tap technique on pain reduction among the patients receiving intramuscular injection. Int J Current Res 2017;9(9):57185–57189.
Najafi SS, Nazaribin S, Momennasab M, Yoosefinejad AK. The effect of manual acupressure (Point BL32) on pain associated with intramuscular injections of magnesium sulfate. J Acupunct Meridian Stud 2019;12(2):67–72.
Salari M, Estaji Z, Akrami R, Rad M. Comparison of skin traction, pressure, and rapid muscle release with conventional method on intramuscular injection pain: a randomized clinical trial. J Educ Health Promot 2018;7:172.
Shehata OSM. Effects of Helfer skin tapping and Z-Track techniques on pain intensity among hospitalized adult patients who receiving intramuscular injection. Int J Novel Res Healthc Nurs 2016;3:77–94.
Ramadan RH, Soliman HM, Othman WS. Effect of cryotherapy versus Heifer Technique on pain intensity among adult patients receiving intramuscular injection. IOSR J Nurs Health Sci 2018;7(6):79–95.
Mehta P, Dhapte V, Kadam S, Dhapte V. Contemporary acupressure therapy: adroit cure for painless recovery of therapeutic ailments. J Tradit Complement Med 2016;7(2):251–263.
Brazeau GA, Cooper B, Svetic KA, Smith CL, Gupta P. Current perspectives on pain upon injection of drugs. J Pharm Sci 1998;87(6):667–677.
Nicoll LH, Hesby A. Intramuscular injection: an integrative research review and guideline for evidence-based practice. Appl Nurs Res 2002;15(3):149–162.
Le May S, Ballard A, Khadra C, Gouin S, Plint AC, Villeneuve E, et al. Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale. Pain 2018;159(8):1508–1517.
Kim H, Neubert JK, San Miguel A, Xu K, Krishnaraju RK, Iadarola MJ, et al. Genetic influence on variability in human acute experimental pain sensitivity associated with gender, ethnicity and psychological temperament. Pain 2004;109(3):488–496.
Edwards CL, Fillingim RB, Keefe F. Race, ethnicity and pain. Pain 2001;94(2):133–137.
Taddio A, Ilersich AL, Ipp M, Kikuta A, Shah V. HELPinKIDS Team Physical interventions and injection techniques for reducing injection pain during routine childhood immunizations: systematic review of randomized controlled trials and quasi-randomized controlled trials. Clin Ther 2009;31:48–S76.