SynthesisPloS one2021
The effect of intramuscular injection technique on injection associated pain; a systematic review and meta-analysis.
Synthesis in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 7 registered trials, which are not on this map. Cited by 20 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Effect of ShotBloker and Helfer Skin Tap Technique on Pain and Fear During Intramuscular Injection in Children Aged 6-12 in the Pediatric Emergency Unit
Evaluation of the Efficiency of Training for Nurses to Use the Z Technique in Intramuscular Injection Application
Efficacy of the Combination of " Z-track " and " Airlock " Techniques During Intramuscular Injection of Haloperidol Decanoate in Adult Patients With Schizophrenic or Related Disorder : A Multicenter Randomized Controlled Trial
The Effect of Cold Spray and Ice Applied During Intravenous Access on Pain and Fear in Children Aged 7-15 Years in Pediatric Emergency Unit
The Effect of the Helper Skin Tap Technique and Buzzy® Application on the Level of Pain and Anxiety Experienced by Children During Vaccination
Effect of Acupressure Therapy on Pain, Injection Fear, and Post-Injection Satisfaction in Patients Undergoing Intramuscular Injection
The Effects of Cold Spray and Stress Ball Methods on Perceived Pain, Comfort, and Satisfaction During Intramuscular Injection: A Randomized Controlled Trial
Who cites it
20 citing papers in PubMed, 3 syntheses or guidelines pooled it, 53 citations in OpenAlex.
- A Systematic Review and Meta-Analysis of Pharmacological and Physical Interventions Directed at the Injection Site for Reducing Distress During Vaccine Injections.The Clinical journal of pain · 2026Pooled it
- The Effectiveness of Ketorolac in Relieving Pain Associated With Root Canal Therapy: A Systematic Review and Meta-Analysis.Clinical and experimental dental research · 2026Pooled it
- Adverse effects of dorsogluteal intramuscular injection versus ventrogluteal intramuscular injection: A systematic review and meta-analysis.Nursing open · 2023Pooled it
- Evaluation of the efficacy of manual pressure and local cold spray application in reducing pain caused by human anti-D immunoglobulin injection in pregnant women: a randomized controlled study.BMC pregnancy and childbirth · 2026Trial
- Cabotegravir + Rilpivirine Long-Acting: Overview of Injection Guidance, Injection Site Reactions, and Best Practices for Intramuscular Injection Administration.Open forum infectious diseases · 2024Trial
- Comparison of the effect of intramuscular injection from two different sites on pain and fear in children: a randomized controlled study.Revista da Associacao Medica Brasileira (1992) · 2024Trial
- The association between patient- and procedure-related factors and patient-reported intraprocedural pain during fluoroscopically guided lumbar epidural injections: A real-world cohort study.Interventional pain medicine · 2026Article
- Article
- Efficient Loading of Rabeprazole Sodium via Porous Anion Exchange Resin for Enteric Delivery.AAPS PharmSciTech · 2026Article
- Inhalation: A Smart Strategy and Increasing Potential for Drug Delivery.Drug design, development and therapy · 2026Review
- Identification of factors related to pain from musculoskeletal injections.PM & R : the journal of injury, function, and rehabilitation · 2026Article
- The Impact of Cold Application on Pain Reduction in Adult Patients Receiving Intramuscular Injections: A Systematic Review.Florence Nightingale journal of nursing · 2025Article
- Deltoid muscle intramuscular injection methods examining pain comfort satisfaction and fear in ShotBlocker helfer skin tap and standard techniques.BMC nursing · 2025Article
- Ventrogluteal site as the preferred choice for pediatric intramuscular injections: impact on pain and fear.Revista da Associacao Medica Brasileira (1992) · 2025Article
- Article
- Thermal imaging of local skin temperature as part of quality and safety assessment of injectable drugs.Heliyon · 2024Article
- Utilization of local pressure devices in pain management during injections: scoping review.Revista brasileira de enfermagem · 2024Article
- Music medicine to improve the tolerability of onabotulinumtoxinA injections for chronic migraine: an open-label prospective cohort study.BMJ neurology open · 2023Article
- Revolutionizing Fallopian Tube Evaluation in Infertility: Transvaginal Sonography Case Study.International journal of women's health · 2023Article
- Production and validation of an educational video on the use of the Z-Track Technique.Revista brasileira de enfermagem · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimTo review the effect of different intramuscular injection (IMI) techniques on injection associated pain, in adults.
methodsThe review protocol was registered on PROSPERO (CRD42019136097). MEDLINE, EMBASE, British Nursing Index and CINAHL were searched up to June 2020. Included studies were appraised and a meta-analysis, where appropriate, was conducted with a random effects model and test for heterogeneity. Standardised mean difference (SMD) with a 95% confidence interval in reported injection pain (intervention cf. control) was reported.
results29 studies were included in the systematic review and 20 studies in the meta-analysis. 13 IMI techniques were identified. 10 studies applied local pressure to the injection site. Of these, applying manual pressure (4 studies, SMD = -0.85[-1.36,-0.33]) and Helfer (rhythmic) tapping (3 studies, SMD = -2.95[-5.51,-0.39]) to the injection site reduced injection pain, whereas the use of a plastic device to apply local pressure to the skin (ShotBlocker) did not significantly reduce pain (2 studies, SMD = -0.51[-1.58,0.56]). Acupressure techniques which mostly involved applying sustained pressure followed by intermittent pressure (tapping) to acupressure points local to the injection site reduced pain (4 studies: SMD = -1.62[-2.80,-0.44]), as did injections to the ventrogluteal site compared to the dorsogluteal site (2 studies, SMD = -0.43[-0.81,-0.06]). There was insufficient evidence on the benefits of the 'Z track technique' (2 studies, SMD = -0.20[-0.41,0.01]) and the cold needle technique (2 studies, SMD = -0.73[-1.83,0.37]) on injection pain. The effect of changing the needle after drawing up the injectate on injection pain was conflicting and warming the injectate did not reduce pain. Limitations included considerable heterogeneity, poor reporting of randomisation, and possible bias in outcome measures from unblinding of assessors or participants.
conclusionsManual pressure or rhythmic tapping over the injection site and applying local pressure around the injection site reduced IMI pain. However, there was very high unexplained heterogeneity between studies and risk of significant bias within small studies.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.