The Role of Stress in Venipuncture Pain in Adolescents: Secondary Analysis of a Prospective Observational Study

Abstract

Background/Objectives: Venipuncture is a painful and distress-inducing procedure, especially in adolescents. However, the effect of stress on venipuncture pain remains unclear. This study investigated the relationships between stress (venipuncture-related and general stress) and venipuncture pain intensity and unpleasantness, hypothesizing that higher stress levels would be associated with greater pain levels. Methods: Forty-two adolescents (five boys, mean age 12.2 ± 1.4) participated in the study, which included completing questionnaires and a blood draw. General stress was assessed using the Perceived Stress Scale. Before the blood draw, participants were asked to rate their venipuncture-related stress level using a Visual Analog Scale (VAS). Following venipuncture, participants rated their pain intensity and pain unpleasantness using the VAS. Nineteen participants returned for a similar study visit after 1 year. Regression models were used to assess the relationships between pain and stress. In addition, correlations were used to examine the relationships between baseline and 1-year follow-up stress and pain levels. Results: Only baseline venipuncture stress, but not general stress, was related to venipuncture pain intensity (estimate (SE) = 0.185 (0.046), t-ratio = 4.00, p < 0.001) and pain unpleasantness (estimate (SE) = 0.378 (0.116), t-ratio = 3.27, p = 0.002). Baseline stress levels were related to stress levels at 1-year follow-up. However, this was not found for pain levels. In addition, stress at baseline did not impact pain levels at 1-year follow-up. Conclusions: General stress may be different from venipuncture stress, with the latter having a greater influence on venipuncture pain. Developing interventions focused on reducing stress related to venipuncture in adolescents could assist in reducing pain and increase willingness to undergo needle procedures.

Keywords: blood draw; needle pain; stress; venipuncture pain.

Figure 1

Changes in stress and pain levels from baseline to 1-year follow-up. (A) Venipuncture stress (0–10 Visual Analog Scale). (B) General stress assessed via the Perceived Stress Scale (PSS). (C) Venipuncture pain intensity (0–10 Visual Analog Scale). (D) Venipuncture pain unpleasantness (0–10 Visual Analog Scale).

Figure 2

No significant associations between stress at baseline and venipuncture pain after 1 year. (A) Association between venipuncture stress at baseline and venipuncture pain intensity after 1 year. (B) Association between venipuncture stress at baseline and venipuncture pain unpleasantness after 1 year. (C) Association between general stress at baseline and venipuncture pain intensity after 1 year. (D) Association between general stress at baseline and venipuncture pain unpleasantness after 1 year.