Tuesday, August 9, 2011

Needle Phobia-and how to get over it...maybe

I have been meaning (truly) to write this blog post for some time-it seemed that other things got in the way.

At one point I actually was going to sell the information under the somewhat misguided notion that people ONLY appreciate and value information that they pay for.

MANY people, and interestingly MEN are in the majority; suffer from needle phobia or one of the related phobic behaviors.

According to recent statistics from the NIH as many as 10 %( or more) of the population has some degree off fear of needles or injections to the point that they can be considered “PHOBIC”.

There are three specific phobias where needles are concerned:
Belonephobia: fear of needles
Aichmophobia: fear of pointed objects
Trypanophobia: fear of injections

Most phobic personalities are either afraid of injections or the actual hypodermic or in some cases a combination of both to varying degrees.

In polling an unscientific group of friends and acquaintances I found that almost 100% of the 20 odd people I spoke too expressed some discomfort when facing the idea of a shot or blood test.

More than half of my test group said they would “rather take a pill” that get an injection in the case of illness (regardless of the fact that the injection might speed up healing).

Finally about 30% expressed serious anxiety and phobic feelings about blood tests, hospitals and fear of the unknown when it came to injections, hypodermic syringes and other topics concerning possible situations involving the POSSIBILITY of a procedure involving a needle.

Only about 10% expressed that they actually felt high levels of apprehension or fear when they saw a hypodermic or the doctor told them they would need an injection or a needle stick of some sort.

While by no means do I present my results as scientific fact for the population as a whole, the results are close enough to actual clinical studies to say that needle phobia is a large enough issue to address and treat with one’s family or primary care physician.

Personally I am distressed at how many physicians continue to have a halcyon attitude (it’s only a little stick)when it comes to an issue which I believe from personal experience cause people to avoid testing for such things as HIV and other serious medical issues because there might be a needle involved.

Luckily I have a compassionate and understanding doctor who feels that when adults are genuinely phobic of needle sticks to the detriment of their medical health and wellbeing the subject needs to be addressed and if possible overcome.

A slightly controversial solution is EMLA cream-a topical anesthetic which is offered now in a couple of generic versions (and formulas).

EMLA as we will be discussing it is a white crème which comes in a tube and is 2.5% Lidocaine and 2.5% Prilocaine.

You put an ample amount on the area to be stuck (such as the inside of your arm at the elbow for a blood test or the back of your hand for an IV treatment, cover it with a large “occlusive” dressing (read BIG BANDAID) wait two hours and you have a numb area.

Earlier I used the work controversial in relation to EMLA.

The controversy comes from a) whether or not it actually works to the point that it is beneficial for treating phobic patients and b) the abuses that it is put to by people who employ the cream for such purposes as tattoos and piercings away from medically controlled settings.

EMLA is strictly by prescription and should be used under the guidance of a licensed medical professional.

It is not for any purpose other than those outlined in the information that accompanies the cream and should never be used in the course of recreational activities with needles such as “play piercing” or other sexual adventures nor for tattooing, scarification or other body modifications unless a medical professional is in attendance.

EMLA was almost removed from the market due to abuse of the product by those who found it a more comfortable way to attain the various body modifications they were seeking and literally became a black market controlled substance like many other prescription analgesics.

Insurance companies began to stop covering its use and in some cases required not only a medical prescription but a psychological evaluation as well.

In Great Britain this double proof was required for diabetics who were insulin dependent and needle phobic.

EMLA can be a huge part of overcoming a genuine phobia of needles and needle sticks.
Routine blood work becomes a much more comfortable procedure.

Those who must have infusions of medicines for Rheumatoid disease, Chemotherapy and other frequent needle sticks and hospital stays will be more comfortable and less apprehensive when it comes to procedures involving needles.

More comfortable patients make for less stress on medical staff.

The question that I found difficult if not impossible to get a definitive answer on is this:” If children are provided with EMLA at an early age would the association of “painless” needle sticks reduce the amount of needle phobias overall?”

Again I was met with the “It’s just a little stick.” or “You need anesthetic for a quick pinch?” mentality for many of the doctors, nurses and phlebotomists I talked to.

Pediatricians and Oncologists were both more likely to endorse the use of topical anesthetics for routine procedures.

One Gerontologist said that he uses EMLA in chronically hospitalized elderly patients strictly for their comfort and the added ease to hospital staff who sometimes have to search for useable veins after lengthy hospitalization.

None of those to whom I spoke were willing to go on record as endorsing even a 2 part Lidocaine, Prilocaine cream (much less a name brand) when dealing with phobic patients.

Numerous references under an “Online” search returned endorsements for such uses as numbing to prepare for laser hair removal, a new spray for premature ejaculation and passing references to numbing for blood draws etc.

NOT ONE addressed needle phobia or any related topic.

Phobic behaviors, especially in the United States, are still looked upon as a general annoyance in all but the most extreme cases.

Hospital staffs often have never heard of EMLA or find the use of a topical anesthetic for a simple needle stick “Ridiculous”.

Off the record many who are responsible for those “simple needle sticks“ have opinions about how much such a simple tool would help not only their patients experiencing a more comfortable medical procedure but easing the personal tensions of medical professionals who are responsible for the discomfort (however much needed).

If you are a person who has serious fears surrounding injections or blood draws or who is facing the need for frequent sticks due to disease or chemotherapy, insist on discussing the matter with your doctor or Physician’s assistant and try EMLA or a similar topical anesthetic.

Be sure you get advice on how and where to apply the product and allow a full two hours under an occlusive dressing for full effectiveness.

A Neurologist shared an interesting piece of information about his male patients who spend a great deal of time in the gym.

It seems that while building healthy strong bodies they are also pushing nerves up over those muscles which can make injections more uncomfortable.

EMLA can be the answer and prevent the light headedness and fainting that embarrasses many of the “Macho Guys” and prevents them from returning for future treatment.

The trade name EMLA (an abbreviation for Eutectic Mixture of Local Anesthetics) refers to the two part Lidocaine/Prilocaine mixture.

Single part Lidocaine creams and other topical anesthetics are available however the concensus among medical professionals ( interviewed for this report) is that they do NOT work as well as the 2 part products.

While some pain may be experienced even with the use of EMLA during some procedures it is significantly reduced and more easily tolerated.

Repeated and regular use of a topical anesthetic may help alleviate phobic reactions to needle sticks however the product may need to be combined with professional counseling with a mental health professional for maximum benefit.

4 comments:

  1. I read this with great interest. I am needle phobic but once upon a time I wasn't.
    I used to let the student Midwives practice on me when they had to learn how to take bloods and it didnt bother me one bit. Then I decided to be a decent person and give my "pint of blood" for our Blood transfusion Service and almost fainted and ever since have had a HUGE issue with needles either through injections or blood letting. I do wonder if Emla would be the answer or if its so deeply ingrained in me that even the thought of it makes me squirm now. Even typing here is making me feel sicky!!!!
    Hope all is well with you, I am thankfully almost better so will have my item to you in the next 48 hours. Phew what a stinky bug its been.
    Hxxxx

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  2. When you can't feel the stick the fear goes away.I was VERY needle phobic and my doctor managed to get me through it.
    You may find that you have to insist on a topical product-try to find the Lidocaine/Prilocaine combo-as stated in the artical there are alternative choices in Europe-I do not have empirical data on those.

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  3. Your numbers are spot on, Rick. I research needle pain and needle phobia. The device Buzzy combines vibration and cold to block out the sharp sensation of the poke. It works for adults, so we got an NIH grant to see if it would work for children to decrease the development of needle phobia. Finished data entry this month, but so far it seems that the older the better, and even adolescents who tend to faint don't do so with Buzzy. The babies are still crying, likely because the cold adds about 60% in adults, and the physiology of the cold may not work in the same way for younger kids. BTW, LMX4 is an over the counter topical anesthetic. Works as well as EMLA for IVs and is studied for shots too, but it may be too superficial for a deep intramuscular shot.

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  4. Nice to hear from you and thanks for your input-happily recvd! I tried two over the counter topicals and even did a "Double blind" OTC vs Rx-the EMLA won hands down. The hardest part of the EMLA experience is making a large enough field and being aware of exactly the location of the vein to be tapped. I have an uncanny sense of where my veins are but have, on occasion, made an anesthetic field that put the transitional edge of the numb area right on the target. This then offers a much dimisninshed but not painless stick. My horror has been born from how many nurses and phelbotomists are completely unaware there are solutions like EMLA and even doctors seem to find them more of an annoyance that a help with nervous patients-hence my irritation with the "little pinch" analogy!

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