Making vaccinations less painful and scary

Its goal is to increase vaccination rates and reduce the spread of disease globally – so the World Health Organization turned to the University of Toronto's Anna Taddio. 

Next week, the world-renowned leader in childhood pain management travels to Geneva to present research and recommendations on reducing pain, distress and fear during vaccinations.

“I’m hoping the WHO will find some recommendations from our work that are suitable on a global level and that they will develop a WHO guideline about pain mitigation during vaccination,” says Taddio, a professor at U of T’s Leslie Dan Faculty of Pharmacy. “This would have an enormous impact on improving pain management practices globally.”  

Taddio leads the Help ELiminate Pain in Kids (HELPinKIDS) project, an inter-disciplinary initiative that brings together clinicians, scientists, policy makers and educators. As many as 10 per cent of people are believed to skip vaccinations due to fear of needles and pain, so the team is working to raise international awareness about inadequately treated pain during childhood immunization injections – and to provide solutions. 

“Health-care professionals weren’t doing what I knew they were supposed to do to prevent pain,” says Taddio. “They weren’t using the pain management tactics published in scientific journals. I realized that I needed to work on bringing the science of pain management into the real world.”

Contacted in December for an initial consultation with the WHO Secretariat about her work in pain mitigation, Taddio was then invited to a meeting to discuss global relevance of her pain management recommendations. 

Michael Kennedy writes about health issues for U of T News. He spoke with Taddio before she left for Switzerland. 

Why is your work around pain management in children so important? 
At present, pain is not routinely managed and most children are distressed during vaccine injections. This results in a negative experience for children and onlookers, including parents and immunizers. Concerns about pain lead parents and health care avoiders to avoid or delay vaccinations in children. When children are old enough, they may refuse vaccinations themselves because of concerns about pain. It is accepted that about 10 per cent of people are not vaccinated specifically because of concerns about needle pain and needle fear. This contributes to the risk of outbreaks of vaccine-preventable diseases.

Is there any pain associated with the vaccine itself or just from the needle?
Yes, the vaccine itself causes pain – some vaccines more than others.

What about the MMR vaccine?
We have two brands of MMR vaccine currently being used and one is very painful and the other is not. The more painful one is the one being used most often.

What are you sharing with the World Health Organization? 
We will be discussing evidence-based ways to reduce pain that are suitable for global implementation.

Evidence-based ways to reduce pain fall into different categories; physical (body position and activity), procedural (injection techniques), pharmacological (pain medicine), and psychological (thoughts and behaviours). For the best results, people should try to combine strategies from the different categories.

Patients/parents/children can’t do much about injection techniques, but they can affect other factors. For instance, children should be sitting up or held in a cuddle by parents (if young child) as an example of a physical intervention. Topical anesthetic creams can be applied to the injection site before the appointment to numb the skin (these are drugs that are available at the pharmacy). Babies can be breastfed during the actual needle poke/vaccine injection or given sugar water just prior to the injection. Children can be distracted with psychological strategies (e.g., blowing pinwheels, movie/music on electronic device).

Your research has the potential to reduce pain caused by immunizations – could this lead to higher vaccination rates? 
For the most part, people are unaware that there are ways to reduce pain from needles. About one quarter of adults and two-thirds of children are afraid of needles. If people can learn about this research and ways to reduce pain, they can use them to reduce suffering, and improve their experience with immunization. Preventing negative experiences with pain, particularly in childhood, can increase vaccine uptake and also prevent needle fears from developing and spilling over to other health care behaviours. When people are avoidant due to needle fear, there is a potential negative impact on their health as a result (e.g., blood tests, dental visits, and so on). 

Why did you choose to focus your research on pain management? 
Sadly, pain is under-prioritized, even though it contributes to unnecessary suffering and is contrary to accepted standards (i.e., pain relief is a basic human right, ‘at first, do no harm’).

Pain is often the most important concern for patients and contributes to morbidity/mortality through health care avoidance. That pain is considered a ‘normal’ part of vaccination rather than a ‘side effect’ of vaccination needs to be changed – it is the most common side effect of vaccination and needs to be mitigated.