Keith Lamb spent thousands of dollars and years of torment trying to solve his fear of needles problem so he could have basic medical and dental care. He was 37 years old before he could muster enough courage to have a blood test.1
Lamb, who has posted a website called “The Needle Phobia Information Site,” (www.needlephobia.com) traces his phobia back to childhood inoculations. “It was an experience from h_ll,” he writes on his website. “I was treated like a baby and a wimp — doctors insulted me for being so uncooperative. I distinctly remember being restrained and forced to undergo needle punctures.”
Lamb is among approximately 10% of the population who has a fear of needles. Needle phobia is a complex set of different conditions that causes people to avoid medical needle procedures. Its origins differ among individuals. About half of needle-phobia cases are actually a medical condition, probably with specific genetic origins, and not a true phobia at all. About 80% of needle phobics have a first-degree relative (i.e., parent, child, or sibling) with needle phobia — evidence that needle phobia has a genetic component. In these cases, any perceived fear is actually directed mostly toward the physical reaction of one’s body (known as a vasovagal reflex reaction) to needle procedures (rather than the needle procedure itself), these individuals seem to have an automatic physical reaction to needle procedures. Many of them actually fear the vasovagal reflex reaction more than they fear needles. The needle procedure is what triggers the automatic vasovagal reflex reaction.
Procedures that are painless for some individuals cause intense pain in others.
In about 30% of needle-phobic individuals, the condition is more of a classic phobia generated by traumatic experiences during childhood such as in Lamb’s case.1 “Usually, a child has an initial traumatic experience of being forcibly held down by medical personnel and poked with needles without any effort on the part of medical personnel to relieve their pain or anxiety,” says Jerry Emanuelson, science writer, Futurescience LLC, Colorado Springs, CO, who is also a self-proclaimed needle phobic with an informative website: “The Needle Phobia Page” (www.needlephobia.com).
Additionally, some individuals have an acute sensitivity to pain in needle procedures. Procedures that are painless for some individuals cause intense pain in others. Many people have a combination of different types of needle phobia.
Worst-case scenarios
Needle phobia is one of the largest causes of preventable medical disorders and death in the industrialized world, according to Emanuelson. The preventable illness and death that results directly from needle phobia cannot be documented since those individuals avoid the medical profession completely.
There have also been several cases of death as a direct result of the vasovagal reflex reaction, principally due to the deep plunge in blood pressure that some people experience with this reaction. These deaths usually occur in individuals who have other health problems that compromise their ability to tolerate the vasovagal reflex reaction.
For needle phobics with the tendency to the vasovagal reflex reaction or with hypersensitivity to pain, Emanuelson recommends Eutectic Mixture of Local Anesthetics or EMLA cream (a prescription topical anesthetic cream). For individuals with the vasovagal reflex reaction, the reaction is often triggered by the sensation of the needle going into the body, especially if the needle enters a vein. An anesthetic can remove this sensation, and therefore block the vasovagal reflex reaction. A technique called “applied tension” can also be useful for those with a tendency toward the vasovagal reflex reaction.
Emanuelson maintains that all phlebotomists should have an iontophoresis unit with the proper lidocaine-based solution to properly numb the site of the needle procedure. “Unfortunately, we are a long way from a situation where this is feasible for phlebotomists,” he says. “In the meantime, phlebotomists should have a place where patients can have needle procedures while lying down, preferably with their legs elevated above their head. Needle phobic patients should be encouraged to take their time getting up, and to stand up very slowly.”
A new solution
To assist children who dread the needle, Amy Baxter, MD, FAAP, FACEP, CEO, MMJ Labs, invented a device called Buzzy (www.buzzy4shots.com). She was inspired after her son became a needle phobic. “He had always been great with shots, but for his four-year immunizations, I had topical anesthetics in place and a distraction ready to go,” Dr. Baxter recalls. “Out of the nowhere the nurse said, ‘Hold still or this is really going to hurt!’ He held still, but then he threw up and was terrified of needles after that.”
Buzzy provides natural pain relief by confusing a body’s own nerves and distracting attention away from the poke, thereby dulling or eliminating sharp pain. It combines cold and vibration to block sharp pain transmission, just as putting a burned hand under water makes it better. “I knew that the body could stop pain naturally using something called ‘gate theory,'” Baxter explains. “If you bang your knee and rub it, the pain stops. If you smash your finger and shake it, it helps the pain. While in the car, I got the idea that vibration would work. My husband suggested frozen peas under the vibration.”
Results demonstrating Buzzy’s effectiveness in children ages four to 18 for IV sticks were presented at the American Academy of Pediatrics national conference in October 2009, and Dr. Baxter currently has a National Institutes of Health grant to study the effects of Buzzy for pediatric immunization pain.
Karen Lynn is a freelance medical writer and editor.
