Mechanisms of “Cough-Trick” for Pain Relief during Venipuncture: An Experimental Crossover Investigation in Healthy Volunteers

Abstract

Objectives. The easily performed “cough-trick” (CT) reduces pain during venipuncture (VP), although the underlying mechanism remains unclear. The aim was to investigate the pain-reducing effect of CT during VP in comparison with two distraction methods, as well as under the influence of naloxone. Methods. 54 healthy male volunteers participated in 3 investigations. Pain during standardized VP with CT was compared to a “weak” distraction (squeezing a rubber ball; investigation 1; n=20) and to a “strong” distraction (inflating a tourniquet to a given pressure; investigation 2; n=21). In investigation 3 (n=13), pain at a VP without intervention was compared to pain at VP with CT under naloxone; pressure pain thresholds before and after naloxone administration were also measured. Pain was assessed using a 100 mm visual analogue scale. Data were compared within each sample using Student’s t-test for paired samples. Results. Pain intensity at VP with CT was lower than under “weak” distraction (mean difference 5 mm; 95% CI: 0.5 to 9.6; P=0.03). Pain levels under CT and “strong” distraction were comparable. There was no difference between pain under CT after naloxone infusion and pain without intervention. Pressure pain threshold decreased (mean difference 1 mm; 95% CI: 0.1 to 1.0 mm; P=0.02) after naloxone administration. Conclusion. Pain-reducing effect of CT during VP is superior to that of simple motor distraction and equivalent to a complex distraction method. This might be due to the activation of segmental pain inhibitory pathways during coughing indicated through the lack of pain reduction due to CT under opioid antagonist blockage.

Effect of the coughing technique during subcutaneous heparin injection on pain severity and individual satisfaction

“…Injection method I: Before receiving the subcutaneous LMWH injection, the patient was asked to take a deep breath and cough once with moderate intensity to empty her/his lungs. After 10 seconds, the patient was asked to take a deep breath and cough a second time with the same intensity ( 20 ),( 22 )-( 23 ) . During the second cough, the needle was inserted into the tissue.…”

“…The coughing technique increases intrathoracic pressure and stimulation of the autonomic nervous system, thereby causing an increase in heart rate and blood pressure, a higher level of pressure in the subarachnoid space and baroreceptor activation ( 20 )-( 21 ) . The increase in pressure in the subarachnoid space brings the segmental pain prevention pathways into action, and this has the effect of reducing the perception of pain ( 20 ),( 22 ) . It has also been reported that as a result of the Valsalva maneuver, this technique has an antinociceptive effect, reducing the perception of pain in connection with vagal nerve stimulation.…”

“…On the other hand, it has been reported that another mechanism of the coughing technique depends on the method of directing the attention elsewhere and of diverting the attention so that the person does not feel pain ( 29 ) , and that it increases a person’s tolerance of pain ( 23 ),( 30 ) . Studies in the literature dealing with the coughing technique report that it is effective in reducing pain in interventions such as peripheral intravenous catheterization ( 22 )-( 23 ) , taking a blood sample ( 20 ) , or vaccination ( 19 ),( 21 ) .…”

“…In particular, in addition to factors such as an excessive amount of work, a large number of patients and a shortage of time, it was observed that there was a big gap in knowledge of the use of an effective technique which was easy for nurses to use, was simple, and did not involve equipment or cost, to increase individual satisfaction and reduce the pain relating to subcutaneous LMWH injections. Recently, despite reports that the coughing technique is effective in controlling the pain arising from invasive procedures ( 19 ),( 22 )-( 23 ) , it was seen that the effect of this technique had not been investigated in the administration of subcutaneous LMWH injections. Also, it was seen that there were no studies considering this technique along with individual satisfaction, which is a very important parameter in increasing patient trust.…”

Effects of Green Color Exposure on Stress, Anxiety, and Pain during Peripheral Intravenous Cannulation in Dental Patients Requiring Sedation

“…Previous studies have found increases in sAA and perceived stress levels from baseline in patients subjected to the acute stress associated with venipuncture [ 21 , 28 ], which is in agreement with our results. Meanwhile, several other studies have also examined the association between hemodynamic changes and needle pain [ 29 , 30 ]. In those studies, there were no significant changes in hemodynamic variables in the control groups before and after PIC, which is consistent with our findings.…”