Many clinicians have noted nonspecidfic pain modulating effects of injecting NACL0.9% or sterile water or another sterile solution which is considered inactive (used in the control group).
It is hypothesized that subcutaneous and intracutaneous injections modulate pain through:
1/ Dry needling effect: the effect of the needle which penetrates the skin and or muscle tissue such a 1A/ s the bleeding effect (blood contains platelets and growth factors), 1B/ triggerpoint effect when needling myofascial trigger points, 1C/ Gate control effect, 1D Effect on neuroinflammation, TRPV1 receptors,
2/ Volume effect: expansion of the extracellular space stimulates peripheral nerve endings
3/ Placebo effect (the placebo effect of an injection is bigger than a pil, but the effect seems to lessen after repeated sessions)
it have multiple variable can effect sex , age and patient tolerance. I think depend on past experience and pain gate theory
it is psychological fear that causes many of the preconceived ideas that would be helped with a calm quick and proficient technique
Do not "dig" or so I call it if you don't find a vein gently pull the needle back and gently assess whether a small maneuver could quickly get blood return. I find that digging around is extremely painful to patients yet multiple failed sticks lessen trust in the practitioner so there needs to be a very skilled individual to help the pain in this matter.
Also, make sure the patient is hydrated. If they are not DO NOT use a tourniquet, reason being is that you may get access but the vein will immediately blow.
In a clinical setting it is probably mostly explained by #3, the placebo effect. A patient has an expectation that they will feel better when they take a pill or are injected with something, because for your entire life before the sham treatment that has been the case. So, you get your sham treatment and feel better the first time because you have the mindset that you will. But, you figure out after a few times that nothing is actually happening, which explains the tapering effect over multiple treatments (extinction).
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