Inclusion Criteria:  18 years of age or older On maintenance hemodialysis three times per week for four hours per session Receiving hemodialysis therapy for a least six moths at the time of the study Pain level of one or more measured by the Visual Analogue Scale during cannulation Able to communicate in Turkish Willing to participate to the study  Exclusion Criteria:  Known to be difficult to enter the fistula (with more than one cannulation) History of hematoma or stenosis in fistula Having an infection in the fistula area Taking painkillers 3 hours before treatment