It comes as no surprise that many people fear the needle. Even if never pierced by a needle in the past, the mere fact that the pointy end will come in contact with skin sends signals that pain is impending. The anticipation of pain makes the experience even more dreaded and possibly even more painful.

There are many tactics that have been tried to alleviate this. Most tactics focus around distracting the patient by talking, joking or the like. There is the use of counter pressure, wherein the pain from this pressure is supposed to mask the pain from the injection - From experience, this doctor can say that counter pressure does work, but it is in no way less painful than the actual injection. So what other options do we have to offer to patients?

The cough effect

Usichenko et al described a method called the “cough trick” in their joint study. Patients who underwent peripheral venipuncture were measured in terms of the intensity of pain, hand withdrawal, palm sweating, blood pressure, heart rate, and serum glucose concentration. The experience was compared with and without the Cough Trick (CT). The subjects were their own controls and results revealed that pain was reduced by coughing.

It has been shown to be effective in children as well, as shown by the findings of the randomized, controlled, unblinded study by Wallace et al. 68 children from an outpatient department who were getting their routine immunizations were recruited. Each child was instructed to do a warm-up cough and a second cough before receiving the needle puncture. The study’s results that were able to be drawn showed that the cough trick can be a useful way to reduce pain for certain children receiving immunizations.

In addition to the research results, being curious, this doctor decided to randomly try it out on my patients before giving them shots or local anesthesia. Though several patients were not able to serve as controls, there was feedback that coughing did help with the pain. Whether psychologically they tended to believe that the pain was reduced or they were just distracted by the novelty of it all, so far this method seems to be favorable. I still use counter pressure and psychologically prepare the patient for the procedure to provide some ease, but the cough trick is one that I have decided to add to my own list of methods.

The mechanism behind it

Some studies suggest that the cough trick works by the gate control theory of pain. This theory explains that non-painful input would close the "gates” to receiving painful input. With that, it would keep the person from experiencing pain as it cuts off the signal to the central nervous system. Noxious stimuli is therefore suppressed and the person feels no pain. Coughing apparently does the trick by blocking off the pain stimulus from the needle puncture.

Others suggest that coughing serves as a distraction and also as a trigger for an increase in blood pressure. When our blood pressure increases, the perception of pain is also reduced. Despite the overall non-exactness of the exact mechanism, it is definitely a cost-effective and simple way to try on patients of any age to reduce the discomfort of the injection experience. MIMS

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Refusals to vaccinate children have doubled, says Malaysia’s MOH
Importance of adult flu vaccinations in reducing hospitalisations
Excess use of cough medicines among children often ineffective and can be harmful

Sources:
- Usichenko et al, “Reducing venipuncture pain by a cough trick: a randomized crossover volunteer study”, Anesth Analg. 2004 Feb;98(2):343-5
- Wallace et al, “The "cough trick:" a brief strategy to manage pediatric pain from immunization injections”, Pediatrics. 2010 Feb;125(2):e367-73