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Lauchlan Lee-Benton, 18-months-old, is held by his mother, Tina Lee, as he receives a mumps, measles and rubella booster vaccination from public health nurse, Heather Arthur, at the Evergreen Community Health Centre in Vancouver, B.C.,

DARRYL DYCK FOR THE GLOBE AND MAIL/darryl dyck The Globe and Mail



QUESTION: Is there any truth to the notion that coughing while getting a needle helps ease the pain?

ANSWER: Some researchers have tested whether coughing during medical procedures can ease the pain. So far, the results are not compelling. Some research suggests it may act as a distraction, taking attention away from the needle or other procedure. We know that if people are distracted, they tend to feel less pain. For others, it may not work because it is a cue that the procedure is about to happen, heightening fear and making the pain worse.

The bigger issue here is the under-treatment of pain. Our society has always accepted needle pain as a part of 'good health care,' but the truth is, it doesn't need to be. In fact, in the long term it may be dangerous for us not to address needle pain, right from the time of birth. New research tells us that untreated pain can leave a permanent neural imprint or pain memory. Pain memory changes future pain sensations and may also lead to fears of the needle and the doctor. The most common question a child asks when entering a doctor's office is "Am I getting a shot today?" The reason for this is simple: Needles hurt, and that's what children remember! And they remember for a lifetime.

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It is estimated that up to one in four people have a fear of needles.

The consequences are that they may avoid the health-care system because a needle might be part of their care. Think of the missed opportunities for preventive health measures, such as avoidance of doctor's or dentist's appointments, and missed immunizations. We learned from H1N1 how important it is for society to be prepared to be vaccinated; yet less than 40 per cent of people chose to get the vaccine. Pain typically prevents at least five to 10 per cent of people from getting vaccinated.

The good news is there are many proven ways to minimize pain, and parents and health professionals can easily implement them. Pain management uses a "three P" approach: physical, psychological, and pharmacological strategies.

Physical strategies include things like sitting up during procedures (instead of lying down), and rubbing or applying pressure near the site before and during the needle poke. Psychological strategies include deep breathing (for children, this can be done by blowing bubbles or a pinwheel), and distraction (listening to music or watching a video or playing with toys). Pharmacological strategies include using topical anesthetic (numbing) medicines and sugar water for infants. Breastfeeding is considered an effective combination intervention. Fortunately, these treatments are relatively easy for anyone to use. Combining a few of them can also improve pain relief.

Yet a change in the medical community's attitude about pain is urgently needed. This includes acknowledging pain as a side effect of needles that requires treatment, as well as recognizing the value of pain relief as an important aspect of quality (and humane) medical care. We don't need to choose between pain relief and good health care; pain relief is part of good health care.

Dr. Anna Taddio is a pharmacist and adjunct scientist at The Hospital for Sick Children in Toronto and associate professor at the University of Toronto.

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