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Scared of shots? Cough! Answered

The Claim: Coughing Can Blunt the Pain of a Doctor’s Needle
Published: January 25, 2010
THE FACTS Sometimes there are no words that can comfort a patient who fears an injection or the drawing of blood. But there may be one cheap and easy way to ease the needle’s sting.

In the medical literature, it is known as the cough trick. Patients cough moderately just before a shot and then once during it.

How this works is unclear. It could simply be a matter of distraction. Or, as a report in the journal BMJ pointed out, it may have something to do with a brief, cough-induced rise in blood pressure that reduces the perception of pain.

Whatever the mechanism, studies have found intriguing evidence. Two were conducted in 2004, including one three-week study in which doctors measured variables like pain intensity, hand withdrawal and palm sweating as subjects had intravenous needles inserted in their hands — on one occasion while coughing, and on another with no coughing. Coughing, they found, reduced the pain.

In another study, published this month in the journal Pediatrics, scientists at the Mayo Clinic tried the coughing trick on 68 children, ages 4 to 11, receiving immunizations. They found that it eased pain in Hispanic and white children, but not in black children — a finding they could not explain.

And like any method, it has its obvious flaws: coughing too vigorously, for example, could cause doctors to miss their mark.

THE BOTTOM LINE Studies suggest that a moderate cough during an injection may forestall pain.

Pretty neat.  Might be a good trick to teach kids so they don't develop phobias.


Placebo effect, anybody?

Nice story, though, and a good one to tell my classes, come the next round of vaccinations.

Forced coughing versus local anesthesia and pain associated with cervical biopsy: a randomized trial.

Schmid BC, Pils S, Heinze G, Hefler L, Reinthaller A, Speiser P.
Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.

OBJECTIVE: Cervical biopsy often causes discomfort and pain. To compare local anesthesia (1% lidocaine) with forced coughing as pain relief, we quantified the actual pain experienced during cervical punch biopsies. STUDY DESIGN: For a prospective trial conducted at the Medical University of Vienna, 68 women undergoing cervical punch biopsies for assessment of abnormal cervical smears were randomized in 2 pain relief treatment groups. Patients' discomfort was assessed immediately after taking the biopsy using at 10-cm visual analog scale. RESULTS: No statistically significant difference was found between pain scores recorded for the 2 groups (P = .47, 95% confidence interval [CI], -0.4 to 1.3 cm). However, when local anesthesia was applied, the examination was significantly prolonged by a median of 2.11 min (P < .001; 95% CI, 1.6-2.8). CONCLUSION: Forced coughing during cervical biopsies reduces patients' discomfort to the same extent as local anesthesia, but is associated with a significantly reduced examination time.
Somewhat compelling, right?

Coughing causes all sorts of muscles to "flex", I don't think it would help (the medical practitioner at least) in a cervical biopsy)


The article stated that coughing might work because of a "rise in blood pressure that reduces the perception of pain" which seems plausible to me.  I've only had one injection where I didn't notice anything at all, and the nurse had rubbed the site vigorously to supposedly confuse the neurons.  No idea what exactly the cause was, but I didn't feel the shot at all because I continued to feel the rubbing sensation after she'd stopped.  That's the only time someone did that before an injection.  It was pretty surreal.

I like to push firmly on the injection site for 15 sec prior to inserting the needle- it does an effective job of blunting nerve sensitivity.   The part that hurts the most is the injection- if done too quickly it hurts no matter the tricks tried.

I don't know about you, but I definitely wouldn't be coughing if someone had something in my ladyparts. 

Speaking as some one who has dealt with patients and pain and "lady parts" for many years and many settings I have this to say-

Placebo effect- a very handy and effective pain reliever,  I have witnessed humans endure excruciating pain with no ill effects because they believed they could- child birth, a child's arm being set, a c-section delivery without anesthesia (fetus was dying- mother made her choice to save it)

Coughing during speculum aided exam is done on a regular basis to look for leaking amniotic fluid- patients tell me it is nothing compared to the speculum itself.

In the USA doctors don't start IV- nurses do and a nurse with any skill can start an IV with the patient squirming all over the place.  Telling a patient to cough or sing is an excellent way to distract them-  (they are usually so dumb-founded by the request for them to sing they don't notice the needle going in!)

Just my opinion- and I certainly don't know everything.