Original article| Volume 10, ISSUE 8, P584-590, November 1995

The use of a topical refrigerant anesthetic to reduce injection pain in children

      This paper is only available as a PDF. To read, Please Download here.


      Early childhood experiences with painful injections may lead to anxiety and fear. These reactions need not develop if steps are taken to reduce the pain associated with injections. The purpose of this study was to assess the efficacy of a refrigerant topical anesthetic in reducing injection pain in preschool children experiencing routine diphtheria-pertussis-tetanus (DPT) immunizations. This double-blind placebo-controlled study was conducted in community health clinics in conjunction with ongoing immunization programs. Ninety subjects, aged 4–5.5 years, were randomly assigned to one of three groups; (a) refrigerant topical anesthetic; (b) placebo topical spray; and (c) no-spray control. Pain was measured subjectively using a four-point visual analogue scale. Both the refrigerant topical anesthetic spray and the placebo spray significantly reduced injection pain. Age was found to be an important factor influencing pain response in this study. Parental anxiety was not a significant factor influencing pain response. In addition, parents were not good at predicting their child's pain. The results of the study support the use of an intervention, such as refrigerant topical anesthetic, as a practical, simple, and effective treatment strategy for reduction of short-term painful procedures like injections.



        • Fradet C
        • McGrath PJ
        • Kay J
        • Adams S
        • Luke B
        A prospective survey of reactions to blood tests by children and adolescents.
        Pain. 1990; 40: 53-60
        • Wong DL
        • Baker CM
        Pain in children: comparison of assessment scales.
        Pediatr Nurs. 1988; 14: 9-17
        • Hester NO
        The pre-operational child's reaction to immunization.
        Nurs Res. 1979; 28: 250-254
        • Eland JM
        • Anderson JE
        The experience of pain in children.
        in: Jaxoc A Pain: a source book for nurses and other health professionals. Little, Brown, Boston1977: 453-473
        • Lander J
        • Fowler-Kerry S
        TENS for children's procedural pain.
        Pain. 1993; 52: 209-216
        • Fowler-Kerry S
        Adolescent oncology survivors' recollection of pain.
        in: Tyler D Krane E Advances in pain research and therapy. 15. Raven, New York1990: 365-371
        • LeBaron S
        • Zeltzer L
        Assessment of acute pain and anxiety in children and adolescents by self-reports, observer reports, and a behavior checklist.
        J Consult Clin Psychol. 1984; 52: 729-738
        • McGrath PJ
        • Craig KD
        Developmental and psychological factors in children's pain.
        Pediatr Clin North Am. 1989; 36: 823-835
        • McGrath PJ
        • Unruh A
        Pain research and clinical management. Elsevier, Amsterdam1987
        • Melzack R
        • Wall PD
        The challenge of pain. Penguin, Ontario1988
      1. Broome ME. The relationship between children's fears and behavior during a painful event. Children's Health Care xxxx;14:142–145.

      2. Jay SM, Ozolins M, Elliott CH, Caldwell S. Assessment of children's distress during painful procedures. Health Psychol xxxx;2:133–147.

        • Katz ER
        • Kellerman J
        • Siegel SE
        Behavioral distress in children with cancer undergoing medical procedures: developmental considerations.
        J Consult Clin Psychol. 1980; 48: 356-365
        • Wolfer JA
        • Visintainer MA
        Pediatric surgical patients' and parents' stress response and adjustment.
        Nurs Res. 1975; 24: 244-255
        • Eland JM
        Pharmacological management of acute and chronic pediatric pain.
        Issues Comprehens Pediatr Nurs. 1988; 11: 93-111
        • Mather L
        • Mackie J
        The incidence of postoperative pain in children.
        Pain. 1983; 15: 271-282
        • Fowler-Kerry S
        • Lander JR
        Management of injection pain in children.
        Pain. 1987; 30: 169-175
        • Peterson L
        • Shigetomi C
        The use of coping techniques to minimize anxiety in hospitalized children.
        Behav Ther. 1981; 12: 1-14
        • Richter IL
        • McGrath PJ
        • Humphreys PJ
        • Goodman JT
        • Firestone P
        • Keene D
        Cognitive and relaxation treatment of pediatric migraine.
        Pain. 1986; 25: 195-203
        • Clarke S
        • Radford M
        Topical anesthesia for venipuncture.
        Arch Dis Child. 1986; 62: 1132-1134
        • Halparin DL
        • Koren G
        • Attias D
        • Pelligrin E
        • Greenberg ML
        • Wyss M
        Topical anesthesia for venous, subcutaneous drug reservoir and lumbar punctures in children.
        Pediatrics. 1989; 84: 281-284
        • Hopkins CS
        • Buckley CJ
        • Bush GH
        Pain-free injection in infants.
        Anesthesia. 1988; 43: 198-201
        • Hallen B
        • Olsson GL
        • Uppfeldt A
        Pain-free venipuncture: effect of timing of application of local anesthetic cream.
        Anesthesia. 1984; 39: 969-972
        • Simons DG
        Myofascial trigger points: a need for understanding.
        Arch Phys Med Rehab. 1981; 62: 1132-1134
        • Simons DG
        • Travell JG
        Myofascial origins of low back pain.
        Postgrad Med. 1983; 73: 72-80
        • Travell JG
        Factors affecting pain of injection.
        JAMA. 1955; 158: 368-371
      3. Gebaur Pharmaceuticals prescribing information on Fluro-ethyl.
        Gebaur Pharmaceuticals. 1988;
        • Eland JM
        Minimizing pain associated with pre-kindergarten intramuscular injections.
        Issues Comprehens Pediatr Nurs. 1981; 5: 361-372
        • Lander J
        • Fowler-Kerry S
        Age differences in children's pain.
        Percept Motor Skills. 1991; 73: 415-418
        • Wright GZ
        • Alpern GD
        Variables influencing children's cooperative behavior at the first dental visit.
        J Dent Children. 1971; 38: 60-64
        • Schechter NL
        • Bernstein BA
        • Beck A
        • Hart L
        • Scherzer L
        Individual differences in children's response to pain: role of temperament and parental characteristics.
        Pediatrics. 1991; 87: 171-177
        • Beecher HK
        The powerful placebo.
        JAMA. 1955; 159: 1602-1606
        • Piaget J
        • Inhelder B
        The psychology of the child. Basic, New York1969
        • Beecher HK
        Surgery as placebo.
        JAMA. 1961; 176: 1102-1107
        • Evans FJ
        The placebo response in pain reduction.
        in: Bonica JJ Advances in neurology. 4. Raven, New York1974: 289-296