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

## TL;DR

This study finds that stress specifically related to blood draws, not general stress, is linked to higher pain in adolescents during venipuncture.

## Contribution

The study distinguishes between general and venipuncture-specific stress, showing only the latter affects pain during blood draws in adolescents.

## Key findings

- Venipuncture-related stress is strongly associated with increased pain intensity and unpleasantness during blood draws.
- General stress levels do not significantly correlate with venipuncture pain.
- Baseline venipuncture stress levels predict stress levels at a 1-year follow-up, but not pain levels.

## 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.