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      Far From “Just a Poke” : Common Painful Needle Procedures and the Development of Needle Fear

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          Abstract

          Background:

          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.

          Objective:

          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.

          Results:

          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.

          Discussion:

          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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          Most cited references106

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          Pain Mechanisms: A New Theory

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            The domain of developmental psychopathology.

            It is the "developmental" component of developmental psychopathology that distinguishes this discipline from abnormal psychology, psychiatry, and even clinical child psychology. At the same time, the focus on individual patterns of adaptation and maladaptation distinguishes this field from the larger discipline of developmental psychology. In this essay a developmental perspective is presented, and the implications of this perspective for research in developmental psychopathology are discussed. A primary consideration is the complexity of the adaptational process, with developmental transformation being the rule. Thus, links between earlier adaptation and later pathology generally will not be simple or direct. It will be necessary to understand both individual patterns of adaptation with respect to salient issues of a given developmental period and the transaction between prior adaptation, maturational change, and subsequent environmental challenges. Some examples are discussed, with special attention to the case of depression.
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              Psychological approaches in the treatment of specific phobias: a meta-analysis.

              Data from 33 randomized treatment studies were subjected to a meta-analysis to address questions surrounding the efficacy of psychological approaches in the treatment of specific phobia. As expected, exposure-based treatment produced large effects sizes relative to no treatment. They also outperformed placebo conditions and alternative active psychotherapeutic approaches. Treatments involving in vivo contact with the phobic target also outperformed alternative modes of exposure (e.g., imaginal exposure, virtual reality, etc.) at post-treatment but not at follow-up. Placebo treatments were significantly more effective than no treatment suggesting that specific phobia sufferers are moderately responsive to placebo interventions. Multi-session treatments marginally outperformed single-session treatments on domain-specific questionnaire measures of phobic dysfunction, and moderator analyses revealed that more sessions predicted more favorable outcomes. Contrary to expectation, effect sizes for the major comparisons of interest were not moderated by type of specific phobia. These findings provide the first quantitative summary evidence supporting the superiority of exposure-based treatments over alternative treatment approaches for those presenting with specific phobia. Recommendations for future research are also discussed.
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                Author and article information

                Journal
                Clin J Pain
                Clin J Pain
                AJP
                The Clinical Journal of Pain
                Lippincott Williams & Wilkins
                0749-8047
                1536-5409
                October 2015
                17 September 2015
                : 31
                : Suppl 10
                : S3-S11
                Affiliations
                [* ]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
                Author notes
                Reprints: C. M. McMurtry, PhD, Department of Psychology, University of Guelph, 87 Trent Lane, Guelph, ON, Canada N1G 2W1 (e-mail: cmcmurtr@ 123456uoguelph.ca ).
                Article
                00003
                10.1097/AJP.0000000000000272
                4900413
                26352920
                fae37e37-945a-497a-a712-e04ea1695963
                Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0/.

                History
                : 10 April 2015
                : 14 June 2015
                Categories
                Needle Fear and Pain Overview Paper
                Custom metadata
                TRUE

                needle,vaccination,pain,fear,phobia
                needle, vaccination, pain, fear, phobia

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