pain/penetration force
insertion speed
Aronson 2012
no effect on pain frequency
effect on pain quality
slow insertion (120mm/min) --> dull pain
fast insertion (1140mm/min) --> sharp pain (most common)
insertion angle
gender
Aronson 2012
men --> higher pain
women --> lower pain
Aronson 2012
low angle (45°) --> high pain
high angle (90°) --> low pain
anatomical region
Aronson 2012
effect on pain
Egekvist 1999
no effect on pain frequency
from thigh to deltoid to abdomen --> PF declined
thigh --> high PF
abdomen --> low PF
Egekvist 1999 - Pain & Mechanical Injury
no effect on pain
Egekvist 1999 - Pain & Mechanical Injury
slow insertion (120mm/min) --> low PF
fast insertion (1140mm/min) --> high PF
needle tube/diameter
Gill 2007
Egekvist 1999 - Pain & Mechanical Injury
small needle size (30G) --> low PF / low frequency of occurence of pain
big needle size (27G) --> high PF / high frequency of occurence of pain
needle gauge effects the frequency of pain
needle tip sharpness
lubrication
Gill 2007
reduction of force & workload possible --> reduced pain
Gill 2007
reduction of force & workload possible --> reduced pain
Arendt-Nielsen 2006
decreased OD --> frequency of pain can be reduced
Chantelau 1991
needle tip geometry
Norman 2012
blinded comparison 5bevels vs. 3bevels: no difference for pain, ease of insertion
blinded comparison: reduction of insertion force with 5bevels not easily distinguished by patients
Norman 2012
abdomen & thigh are the least sensitive areas for tactile discrimination
not blinded comparison: 5bevels --> easier insertion, less painful, more comfortable
Praestmark 2016
PF & SBP increased with needle diameter
Pain intensity not significantly increase with needle diameter
Praestmark 2016
for 32G & 34G: blinded perception of pain intensity does not differ between needle design
needle length
Schwartz 2004
Iwanaga 2009
diameter plays an important role in reducing injection pain and needle anxiety
Valentini 2014
less pain with 33Gx4mm than with 32Gx4mm
reuse
Puder 2004
reuse up to 5 times --> no progressive tip deformity, no increased pain intensity or unpleasantness
Misnikova 2011
reuse up to 7 times --> bacterial contamination, local inflammatory changes, injection pain increase in proportion to needle reuse
Zabaleta-del-Olmo 2016
no clear scientific evidence for or against reuse
novofine 32G 6mm (conical) vs. micro fine plus 31G 5mm --> novofine more convenient, easy to use, less painful, less bleeding/bruising/leakage
McKay 2009
novofine 32G 6mm vs. novofine 30G 8mm: preference for 32G, less painful
31G x 6mm vs. 29G x 12,7mm: no differences in glycemic control, pain & leakage
Schwartz 2004
31G x 6mm vs. 29G x 12,7mm: no differences in glycemic control, pain & leakage
Schuler 1992
reuse up to 12 times --> no contamination of needle. but half of the needles plastic ground, no infection at injection sites
recommend reuse of pen needles as a simple, safe and cost-beneficial procedure (limited to 5 to 10 injections --> needles point becomes more and more blunt, causes pain)
33000 injections in total (1, 3, 6, 9, 12 times)
Haindl 1988
no recommendation of multiple use --> dullness & deflection of needle tip
Miwa 2012
open-label, controlled home use study: 32G x 6mm (conical 3bevels tip) & 32G x 4mm (3bevels) --> equivalent controlling of glycemic levels
more leakage and bleeding for 4mm (not significant)
4mm needle is less painful, easier to insert, preference on the whole
Miwa 2012
4mm needle is less painful, easier to insert, preference on the whole
more leakage and bleeding for 4mm (not significant)
open-label, controlled home use study: 32G x 6mm (conical 3bevels tip) & 32G x 4mm (3bevels) --> equivalent controlling of glycemic levels
Hirsch_Gibney 2012
reduced pain of 32G x 4mm vs. 31G x 5mm and 8mm
equivalent glycemic control in obese and non-obese patients
Hirsch_Gibney 2012
reduced pain of 32G x 4mm vs. 31G x 5mm and 8mm
equivalent glycemic control in obese and non-obese patients
Berard 2014
open-label study with 66 obese patients, 6 month: 31G x 5mm vs 8mm: no difference in pain or less pain with 5mm
differences in pain reported are associated with needle length
5mm was more comfortable, easier to use, equally effective in delivering insulin
Aronson 2013
ETW 5bevel vs. similar size TW? 3bevel??: improved flow and pressure, easier to use, lower thumb force, reduced pain, leakage was less
Dau 2017
significantly less injection pain with scalpel bevel design than for triple bevel and regular bevel (dental needle)
more hooks with scalpel bevel design
Mayer 2009
3 bevel 30G vs. 5bevel 29G & 27G
5bevel: additional tipping results in higher piercing resistance and shorter cuts, enlarged coring tendency
Omoigui 2006
same size, diameter and length: 3facet grind (Terumo) vs. 3facet grind, low angle bevel (BD): with BD less pain
Kursat 2013
intensity of pain increased significantly with increasing needle length (4mm vs. 8mm)
Strock 2013
4mm PN less painful than 8mm in high-dose subjects
Bergenstal 2015
4mmx32G vs. 8mmx31G vs. 12,7mmx29G ??? --> 4mm favorable findings for pain, ease of use, overall patients preferences
Saito 2014
G34x4mm vs. G31x5mm vs. G32x6mm
first G31 or G32 then G34
pain improvements with G34, could also be related to needle length (improvement greater with G32)
Steele 2012
bevel design influences the forces required to insert and withdraw dental needles in vitro