Evidence map›Paper›PMID 41880242›Full record

SynthesisThe Clinical journal of pain2026

A Systematic Review and Meta-Analysis of the Effectiveness of Procedural Interventions for Reducing Distress During Vaccine Injections.

Anna Taddio, Vibhuti Shah, C Meghan McMurtry, Eddy Lang, Noni E MacDonald, Kaytlin Constantin, Elizabeth Uleryk, HELPinKids&Adults##

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Clinical journal of pain, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Reducing distress during vaccine injections: 2026 clinical practice guideline update.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
    Guideline
  2. Pooled it
  3. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Anna TaddioProfessor, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON.ORCID 0000-0003-4432-8975
Vibhuti ShahNeonatologist, Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON.
C Meghan McMurtryProfessor, Department of Psychology, University of Guelph, Guelph, ON.
Eddy LangProfessor, Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB.
Noni E MacDonaldProfessor Emerita, Faculty of Medicine, Dalhousie University, Halifax, NS.
Kaytlin ConstantinResearch Associate, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON.
Elizabeth UlerykEM Uleryk Consulting, Mississauga, ON.
HELPinKids&Adults##

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThis systematic review was conducted as part of a 10-year update to a clinical practice guideline about reducing distress during vaccine injections and evaluated procedural interventions (injection techniques) that clinicians and organizations can use. Altogether, 4 clinical questions were included: (1) no aspiration before injection; (2) fast injection; (3) injecting the vaccine causing the most distress last; and (4) reducing fear cues before injection.

methodsPanel members voted on clinical questions and outcomes, as per GRADE methodology. A search strategy was executed across 5 databases: MEDLINE, EMBASE, APA PsycINFO, CINAHL, and ProQuest Dissertations. Randomized and quasi-randomized controlled trials involving individuals undergoing vaccination across the lifespan were eligible and identified in a stepwise fashion involving at least 2 reviewers. The critical outcome was distress, assessed by vaccine recipients or observers. Data were combined using standardized mean difference (SMD) with 95% CIs. Summary statements were developed according to certainty of evidence and magnitude of effect (threshold SMD ≥0.2).

resultsAltogether, 12 studies were included. Meta-analysis of 6 trials indicates that injecting without aspiration may result in a reduction in distress (SMD=-0.77, low certainty), as reported by vaccine recipients and observers. Fast injection may reduce distress slightly, according to self- and observer-report in 2 trials (SMD=-0.27, low certainty). Injecting the vaccine that causes the most distress last likely reduces distress (SMD=-0.73, moderate certainty), as reported by observers in 4 included trials. One trial providing indirect evidence demonstrates that reducing fear cues may reduce distress (SMD=-0.26, very low certainty), but the evidence is very uncertain.

conclusionsProcedural interventions are associated with benefits for vaccination-related distress and provide feasible options for clinicians and organizations to improve the vaccination experiences of vaccine recipients.

Indexed as

InjectionsStress, PsychologicalVaccinationVaccinesHumansVaccinesfearinjection techniquepainrandomized controlled trialsystematic reviewvaccination

Identifiers

PMID41880242
PMCPMC13354264

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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.