Grin and Bear It: Why Smiling Makes Vaccine Shots Less Painful

By Pat Anson, PNN Editor

Over the next few months, tens of millions of people around the world will be getting the first injections of COVID-19 vaccines, with some getting a vaccine that requires two shots to be effective.

Whether it’s a shot for the flu, pneumonia, shingles or COVID, no one looks forward to stabbing pain from the oversized needles often used in vaccinations. Is there anything you can do to help relieve the sting from a needle prick?

An unusual study led by researchers at the University of California, Irvine, found an unexpected way to dull the pain: Put a big smile on your face.

Researchers say that a broad smile -- one that elevates the corners of the mouth and creates crow's feet around the eyes -- can reduce the pain of a needle injection by as much as 40 percent. That genuine smile, known as a Duchenne smile, can also lower your stress and heart rate during a needle injection.

If you find the idea of smiling during an injection a little silly, then feel free to grimace instead. Grimacing uses the same facial muscles as smiling and is just as effective at pain relief, according to researchers.

"When facing distress or pleasure, humans make remarkably similar facial expressions that involve activation of the eye muscles, lifting of the cheeks and baring of the teeth," says lead investigator Sarah Pressman, PhD, a professor of psychological science at UCI. "We found that these movements, as opposed to a neutral expression, are beneficial in reducing discomfort and stress."

To test their theory, Pressman and her colleagues found 231 healthy volunteers who self-reported their levels of pain, emotion and distress while being injected in the upper arm with saline from a 25-gauge needle — the type often used in a flu shot.

Before and during the injection, participants were randomly selected to use either a Duchenne smile, a small smile, a grimace or a neutral expression. All four facial expressions were facilitated by holding chopsticks in their teeth.

Those in the Duchenne smile and grimace groups reported 40% and 39% less pain, respectively, during the injection than the neutral group, while participants in the small smile group had 26% less pain.

The Duchenne smile and grimace groups (images C and D) were also associated with slightly lower stress and heart rates.

“Why did these two disparate expressions perform so similarly? As discussed previously, this overlap could be explained by the fact that similar muscle groups are activated in both expressions,” researchers reported in the journal Emotion.

“Grimacing has long been used as a nonverbal indicator of pain and has been manipulated unintentionally via common medical practices from the Middle Ages that tell individuals to ‘bite down’ on pieces of wood and leather during painful procedures. To our knowledge, this is the first experimental test showing that this natural response to pain is helpful in improving the subjective pain experience.”

The researchers aren’t suggesting a return to the Middle Ages or that you bite down on chopsticks the next time you’re vaccinated. But they do think that “device-in-mouth manipulation” and “creative paradigms to manipulate facial expressions” are worthy of future pain research.     

"Our study demonstrates a simple, free and clinically meaningful method of making the needle injection less awful," Pressman said. "Given the numerous anxiety- and pain-provoking situations found in medical practice, we hope that an understanding of how and when smiling and grimacing helps will foster effective pain reduction strategies that result in better patient experiences."

This Is a Good Year to Get a Flu Shot

By Julie Appleby and Michelle Andrews, Kaiser Health News

Flu season will look different this year, as the U.S. grapples with a coronavirus pandemic that has killed more than 180,000 people. Many Americans are reluctant to visit a doctor’s office and public health officials worry people will shy away from being immunized.

Although sometimes incorrectly regarded as just another bad cold, flu also kills tens of thousands of people in the U.S. each year, with the very young, the elderly and those with underlying conditions the most vulnerable. When coupled with the effects of COVID-19, public health experts say it’s more important than ever to get a flu shot.

If enough of the U.S. population gets vaccinated — more than the 45% who did last flu season — it could help head off a nightmare scenario in the coming winter of hospitals stuffed with both COVID-19 patients and those suffering from severe effects of influenza.

Aside from the potential burden on hospitals, there’s the possibility people could get both viruses — and “no one knows what happens if you get influenza and COVID [simultaneously] because it’s never happened before,” Dr. Rachel Levine, Pennsylvania’s secretary of health, told reporters this month.

In response, manufacturers are producing more vaccine supply this year, between 194 million and 198 million doses, or about 20 million more than they distributed last season, according to the Centers for Disease Control and Prevention.

As flu season approaches, here are some answers to a few common questions:

When should I get my flu shot?

Advertising has already begun, and some pharmacies and clinics have their supplies now. But, because the effectiveness of the vaccine can wane over time, the CDC recommends against a shot in August.

Many pharmacies and clinics will start immunizations in early September. Generally, influenza viruses start circulating in mid- to late October but become more widespread later, in the winter. It takes about two weeks after getting a shot for antibodies — which circulate in the blood and thwart infections — to build up.

“Young, healthy people can begin getting their flu shots in September, and elderly people and other vulnerable populations can begin in October,” said Dr. Steve Miller, chief clinical officer for insurer Cigna.

The CDC has recommended that people get a flu vaccine by the end of October, but noted it’s not too late to get one after that because shots can still be beneficial and vaccination should be offered throughout the flu season. Even so, some experts say not to wait too long — not only because of COVID-19, but in case a shortage develops because of overwhelming demand.

While a flu shot won’t prevent COVID-19, getting one could help your doctors differentiate between the diseases if you develop any symptoms — fever, cough, sore throat — that they share.

Getting a shot protects you from catching the flu and spreading it to others, which may help lessen the burden on hospitals and medical staffs. A flu shot won’t prevent all cases of the flu, but getting vaccinated can lessen the severity if you do fall ill. You cannot get influenza from the flu vaccine.

All eligible people, especially essential workers, those with underlying conditions and those at higher risk — including very young children and pregnant women — should seek protection, the CDC said. It recommends that children over 6 months old get vaccinated.

How effective is this year’s vaccine?

Flu vaccines — which must be developed anew each year because influenza viruses mutate — range in effectiveness annually, depending on how well they match the circulating virus. Last year’s formulation was estimated to be about 45% effective in preventing the flu overall, with about a 55% effectiveness in children.

The vaccines available in the U.S. this year are aimed at preventing at least three strains of the virus, and most cover four. It isn’t yet known how well this year’s supply will match the strains that will circulate in the U.S.

Early indications from the Southern Hemisphere, which goes through its flu season during our summer, are encouraging. There, people practiced social distancing, wore masks and got vaccinated in greater numbers this year — and global flu levels are lower than expected. Experts caution, however, not to count on a similarly mild season in the U.S., in part because masking and social distancing efforts vary widely.

Where can I get a flu shot?

Aiming to avoid risky indoor gatherings, many employers are reluctant to sponsor the on-site flu clinics they’ve offered in years past. And with so many people continuing to work from home, there’s less need to bring flu shots to employees on the job. Instead, many employers are encouraging workers to get shots from their primary care doctors, at pharmacies or in other community settings. Insurance will generally cover the cost of the vaccine.

Some pharmacies are making an extra push to get out into the community to offer flu shots.

Walgreens, which has nearly 9,100 pharmacies nationwide, is continuing a partnership begun in 2015 with community organizations, churches and employers that has offered about 150,000 off-site and mobile flu clinics to date. Walgreens began offering flu shots in mid-August and is encouraging people not to delay getting vaccinated.

Both Walgreens and CVS are encouraging people to schedule appointments and do paperwork online this year to minimize time spent in the stores. At CVS MinuteClinic locations, once patients have checked in for their flu shot, they must wait outside or in their car, since the indoor waiting areas are now closed.

“We don’t have tons of arrows in our quiver against COVID,” said Dr. Kevin Ban, Walgreens’ chief medical officer. “Taking pressure off the health care system by providing vaccines in advance is one thing we can do.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.