FEATURES The Use of ShotBlocker for Reducing the Pain and Anxiety Associated With Intramuscular Injection A Randomized, Placebo Controlled Study ■ N. C ¸ elik, PhD ■ Leyla Khorshid, PhD There are few studies evaluating the effect of ShotBlocker on pain acquired from intramuscular injection, and these are mostly in children. We hypothesized that the use of ShotBlocker, while administering an intramuscular injection, would reduce the pain and anxiety due to intramuscular injection in adults. A randomized, placebo controlled trial was carried out for more than 20 months in 2010-2011 on 180 adults aged 18 to 80 years who received intramuscular injections of diclofenac sodium (75 mg/3 mL) at the outpatient clinic of a hospital. The patients were grouped into 3 groups: control, placebo control, and experimental. The experimental group was given an intramuscular injection of diclofenac sodium with ShotBlocker. Pain intensity was measured through a visual analog scale after the injection and anxiety was measured using Spielberger’s State-Trait Anxiety Inventory. Pulse rate was counted and state and trait anxiety was measured before and after the injection. The Mann-Whitney U test and Wilcoxon and Kruskall-Wallis tests were used to evaluate the data. Patients in the ShotBlocker group had significantly lower pain intensity than those in the placebo and control groups. State anxiety level increased after the injection in the experimental group but did not change in the other 2 groups. ShotBlocker did not affect the pulse rate. Our results suggest that using ShotBlocker during intramuscular injection reduced patients’ pain intensity because of injection but did not reduce anxiety levels. Thus, ShotBlocker is recommended as a pain-relieving tool during intramuscular injection in adults. KEY WORDS: anxiety, injection pain, intramuscular, nurse, ShotBlocker Holist Nurs Pract 2015;29(5):261–271 Administration of intramuscular (IM) injection is one of the basic nursing skills and responsibilities of professional nurses. 1 Intramuscular injections often cause pain and anxiety on patients and, therefore, patients are afraid of receiving injections and may postpone seeking medical help because of painful injection. 2,3 Some of the physiological responses to acute pain are increased heart rate, blood pressure, and anxiety. 4 Author Affiliation: Eskisehir Health Higher School, Eskisehir Osmangazi University, Eskisehir, Turkey (Dr C ¸ elik); and Faculty of Nursing, Ege Uni- versity, ˙ Izmir, Turkey (Dr Khorshid). Study design: NC ¸ and LK; data collection and analysis: NC ¸ ; drafting the manuscript and critical revision: NC ¸ and LK. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: N. C ¸ elik, PhD, Eskisehir Health Higher School, Eskise- hir Osmangazi University, Meselik Campus, 26480, Odunpazarı/Eskisehir, Turkey (ncelik@ogu.edu.tr). DOI: 10.1097/HNP.0000000000000105 BACKGROUND In a situation such as injection, the needle pricked into the skin causes acute pain. 5 Injection pain may result from either injury to nerve fibers from mechanical trauma caused by a needle puncture 2,6 or increased pressure from an accumulation of fluid within the tissues, or sudden distention of tissue from rapid introduction of fluid. 2,7 It has been proposed that a patient’s previous experiences of injection, 2 the pH, osmolarity, viscosity and the amount and administration rate, the chemical nature of the drug that is injected, 7-9 and the length of the needle 7-9 have an effect on the pain associated with IM injection. Many articles have been published about various pharmacological and nonpharmacological methods of reducing IM injection pain. Researches related to this topic have examined procedures that might potentially minimize pain because of IM injection. Studies have investigated the effect of Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 261