"No one takes it seriously": U.S. military personnel with gambling concerns: recommendations for expanding treatment and public health efforts.

Intravenous (IV) catheterization is a routine clinical procedure commonly performed during hospitalization for purposes such as administering medications, fluids, or contrast media. Compared to intramuscular or subcutaneous injections, venipuncture is more efficient and allows for faster drug effects. Its versatility in enabling fluid therapy, medication delivery, and diagnostic testing makes it an essential component of inpatient care [,]. Nevertheless, repeated catheterizations are a common source of physical and psychological discomfort for patients []. Because IV catheterization is not only a physical procedure but also directly triggers an emotional response from patients, it can cause anxiety and fear in addition to physical pain []. Some patients have reported particularly strong fears of venipuncture because of previous experiences of IV infusion []. IV catheterization also causes significant stress for healthcare workers and nurses due to the difficulty in securing venous access. When catheterization is difficult, repeated venipunctures may be required, which further exacerbates distress for patients and work burden among healthcare workers []. As such, some authors [,] have highlighted the need for nursing interventions to reduce pain and stress during IV catheterization and enable easier and more effective venous access. Various interventions have been devised to reduce the pain and stress caused by IV catheterization. These include pharmacological approaches, such as lidocaine patches [], lidocaine ointment [], and aroma hand massage [], which have shown significant pain-relieving effects. However, caution is required when using local anesthetic-based methods due to potential adverse effects, such as skin irritation, rash, discomfort, and delayed onset of action []. In addition, a range of non-pharmacological interventions has been applied to alleviate patients’ anxiety and pain during venipuncture. Among non-pharmacological approaches, distraction techniques—such as music interventions [], video games [], and virtual reality (VR) []—have been widely used to reduce patients’ anxiety and pain. Distraction-based interventions focus attention on visual or auditory stimuli to reduce the perception of the pain. It is also a method to reduce psychological problems such as pain and anxiety. Distraction-based interventions are non-pharmacological method essential for reducing pain, incompetence, and fear that occur during hospital treatment []. Non-medicinal interventions used to alleviate pain from IV cannulation include counter-stimulation techniques such as warm therapy and cryotherapy []. Warm therapy seeks to provide a soothing effect by blocking pain transmission based on the gate control theory; it helps to alleviate ischemia-related pain by inducing vasodilation. Cryotherapy reduces pain by inducing vasoconstriction, restricting local cellular metabolism []. However, warm therapy- and cryotherapy-based interventions have suffered from issues, such as difficulty maintaining a constant temperature [], slowness in achieving appropriate temperatures for pain reduction [], and inapplicability in clinical settings due to the need for prior preparation (before IV cannulation can occur) []. Combining the two interventions can address limitations such as distraction-based interventions may be effective only for children and specific patient groups, and the difficulty of maintaining a constant temperature in warm therapy [,].