Factors affecting dry eye syndrome and quality of life among college students in Korea: a cross-sectional study.

Venipuncture for intravenous injection occupy an important position among the invasive procedures performed by nurses []. Venipuncture is often described as difficult for nurses and painful for patients []. If the pain experience due to venipuncture is repeated, the patient may feel fear of injections, which increases anxiety about future treatment, and if the patient does not actively participate in treatment due to pain, recovery may be delayed []. Most patients experience pain when the needle pierces the skin. Some patients may notice more pain and experience vagal reflexes, or it may lead to low blood pressure and syncope []. Therefore, continued research is needed to reduce patients' pain and anxiety related to venipuncture pain. Previous research has consistently sought to identify methods to reduce the pain and stress associated with IV procedures. Pharmacological interventions, such as the application of topical anesthetics like lidocaine ointment or patches, have shown effectiveness in reducing pain during venipuncture [,]. Similarly, the application of Eutectic Mixture of Local Anesthetics (EMLA cream), consisting of 2.5% lidocaine and 2.5% prilocaine, has demonstrated significant pain-reducing effects []. However, the use of topical anesthetics may result in side effects such as hypersensitivity, skin erythema, swelling, and itching, warranting cautious application []. Additionally, the costs associated with these medications can be a financial burden for patients. Non-pharmacological interventions, including cryotherapy [] and thermotherapy [], have also been employed to alleviate pain during venipuncture. Other methods such as music therapy [], aromatherapy [], distraction techniques using tablet video [], and virtual reality content [,] have also been explored. Among these, thermotherapy is particularly noteworthy for its effectiveness as a nursing intervention for pain management []. Thermotherapy functions by enhancing nerve conduction, stimulating nerve endings, or blocking pain transmission through the gate control theory, thereby providing anesthetic and sedative effects. The relaxation induced by thermotherapy offers comfort, and its vasodilatory effect is particularly useful in alleviating pain associated with muscle spasms due to ischemia []. Research on thermotherapy has shown its effectiveness in reducing subjective pain during arteriovenous fistula needle insertion in hemodialysis patients [] and in decreasing the time required for injections, the number of attempts, and increasing the success rate of first attempts in pediatric emergency patients []. Cryotherapy is a representative non-pharmacological intervention that reduces pain and swelling following tissue damage and suppresses inflammatory responses []. Cryotherapy induces vasoconstriction, which decreases local cellular metabolism and inhibits inflammatory and purulent processes, thereby preventing the accumulation of excess fluid in the injured tissue that could exacerbate pain []. Previous studies have shown that cryotherapy using an ice pack for 5~10 minutes is effective in reducing pain during venipuncture []. Although thermotherapy and cryotherapy are well-established non-pharmacological interventions for pain relief, there is limited evidence supporting their efficacy specifically for needle insertion pain. Furthermore, the inconvenience associated with the application methods of these therapies has restricted their widespread use during intravenous procedures. To promote broader application, it is necessary to address and mitigate the inconveniences related to the application methods of cryotherapy and thermotherapy.