Taddio Anna, Chambers Christine T, Halperin Scott A, Ipp Moshe, Lockett Donna, Rieder Michael J, Shah Vibhuti
Division of Pharmacy Practice, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
Clin Ther. 2009;31 Suppl 2:S152-67. doi: 10.1016/j.clinthera.2009.07.022.
Immunization is regarded as one of the most significant medical achievements of all time. Recently, increasing attention has been paid to the pain resulting from routine childhood immunizations.
This narrative review summarizes existing knowledge about: (1) the epidemiology of childhood immunization pain; (2) the pain experience of children undergoing immunization; (3) current analgesic practices; (4) barriers to practicing pain management in children; and (5) recommendations for improvements in pain management during immunization.
We conducted a search of MEDLINE, PsycINFO, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials for primary research and review articles published from inception of the databases through October 2008. Key search terms included immunization, pain, child/infant, vaccine, and intervention. Additional studies were identified through searches of the reference lists in the retrieved articles. No language restrictions were imposed regarding the type of article (eg, full article, abstract) or language.
Vaccine injections are the most common iatrogenic procedure performed in childhood and a major source of distress for children (of all ages), their parents, and the participating health care professionals, as well as a direct cause of vaccine nonadherence. In addition, lack of adequate pain management during immunization exposes children to unnecessary suffering and the potential for long-term consequences, such as fear of needles. Numerous pain management strategies are available to reduce vaccine injection pain, including: (1) physical interventions and injection techniques; (2) psychological interventions; and (3) phar-macologic and combined interventions. However, adoption of pain-relieving techniques into clinical practice has been suboptimal. The underutilization of pain management strategies can be attributed to a lack of knowledge about pain and effective pain prevention strategies, and the persistence of attitudes about pain that interfere with optimal clinical practices. Current analgesic practices could be improved substantially if all stakeholders involved in immunization (eg, policy makers, practitioners, consumers) participate in efforts to reduce pain. Treating pain during childhood immunization has the potential to reduce distress during the procedure and greatly improve satisfaction with the immunization experience through more positive experiences for children and their families. Other potential benefits include improved adherence to immunization schedules and reduced sequelae of untreated pain.
Immunization is a global health priority. Medical care can be improved if pain management becomes a routine aspect of the delivery of vaccine injections.
免疫接种被视为有史以来最重要的医学成就之一。近来，人们越来越关注儿童常规免疫接种带来的疼痛。
本叙述性综述总结了关于以下方面的现有知识：（1）儿童免疫接种疼痛的流行病学；（2）接受免疫接种儿童的疼痛体验；（3）当前的镇痛措施；（4）儿童疼痛管理实施过程中的障碍；（5）免疫接种期间改善疼痛管理的建议。
我们检索了医学期刊数据库（MEDLINE）、心理学文摘数据库（PsycINFO）、荷兰医学文摘数据库（EMBASE）、护理学与健康领域数据库（CINAHL）以及考克兰对照试验中心注册库，以查找从各数据库建库起至2008年10月发表的原始研究和综述文章。关键检索词包括免疫接种、疼痛、儿童/婴儿、疫苗和干预措施。通过检索所获文章的参考文献列表确定了其他研究。对于文章类型（如全文、摘要）或语言不设限制。
疫苗注射是儿童期最常见的医源性操作，是各年龄段儿童、其父母以及参与的医护人员痛苦的主要来源，也是疫苗接种不依从的直接原因。此外，免疫接种期间缺乏充分的疼痛管理会使儿童遭受不必要的痛苦，并可能导致长期后果，如害怕打针。有多种疼痛管理策略可用于减轻疫苗注射疼痛，包括：（1）物理干预和注射技术；（2）心理干预；（3）药物及联合干预。然而，将疼痛缓解技术应用于临床实践的情况并不理想。疼痛管理策略未得到充分利用可归因于对疼痛及有效疼痛预防策略缺乏了解，以及妨碍最佳临床实践的疼痛观念持续存在。如果参与免疫接种的所有利益相关者（如政策制定者、从业者、消费者）共同努力减轻疼痛，当前的镇痛措施可得到大幅改善。在儿童免疫接种期间治疗疼痛有可能减轻操作过程中的痛苦，并通过为儿童及其家庭带来更积极的体验，极大地提高对免疫接种体验的满意度。其他潜在益处包括提高对免疫接种计划的依从性以及减少未治疗疼痛的后遗症。
免疫接种是全球卫生工作的重点。如果疼痛管理成为疫苗注射操作的常规环节，医疗服务可得到改善。
