If you treat kids, you know about “needle fear.” But this problem is not reserved for kids alone; it’s not to be taken lightly in adults either. It can seriously get in the way when you are trying to provide care, and when it results in a vasovagal response, no one is happy. Sometimes it’s the reason a patient skips an appointment all together.
According to an Australian study, 22 percent of general practice patients expressed a fear of needles, and nearly the same number said they avoided medical care because of this fear. “Needle phobia,” is now included (under blood–injection–injury phobia) in the American Psychiatric Association’s latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and by some estimates affects up to 10 percent of the population.
This prevalence has led to innovations in both psychological and technological solutions to the problem.
Needle fear often begins in childhood, when negative experiences can set a patient up for a lifetime of fear and apprehension. This is why researchers are particularly interested in methods to calm children exposed to needles.
According to a paper published in the Journal of Pediatric Psychology, the most effective methods used by parents and healthcare professionals to help children cope with an injection are “nonprocedural talk, reassurance, and humor.” Sometimes, this is all that is needed to help a patient (child or adult) manage their fear.
In more extreme cases, cognitive behavioral therapy, outside the needle-use setting and in a separate session, is often recommended.
Clinical practice guidelines, published in the May 2016 issue of the journal Cognitive Behaviour Therapy, suggest several levels of exposure-based therapy that can be effective in reducing high levels of needle fear. The recommendations are aimed at adults and children greater than seven years of age and include both in-person and computer-based interventions.
For needle fear, exposure-based therapy typically includes a gradual presentation of aspects of needle procedures in a hierarchical manner of ascending fear. The exposure needs to be of sufficient duration to allow individuals to experience a reduction in fear, learn that catastrophic beliefs of harm are unlikely to occur, or, that if they do occur, they can be tolerated.
These treatment methods are admittedly time consuming and may not be within your neurology practice purview. They do suggest, however, some benefit in referring patients to a specialist in cognitive behavior therapy (CBT).
Many of the technological solutions for patients who experience needle fear is aimed at mechanically decreasing the pain experienced during a needle stick. One way this is being accomplished is by taking advantage of the Gate Control Theory of Pain (first suggested in 1965 by Melzack and Wall).
This involves the introduction of vibration or pressure at the site of the injection, before or during the procedure, to override pain signals to the brain. Many studies have been done to show the benefit this approach, including this 2015 study and this 2016 study.
Needle technology has also advanced to reduce the pain of injections. Engineers at Ambu, Inc. have made innovations in materials and design with an eye toward decreasing pain. Neurologist in private practice, Dr. Gretchen Campbell, says the Ambu needles are her favorite, “They puncture the skin more easily than others, and that translates to less pain.”
Ambu needles are able to do this because of their special coating and tip design. The tip of the needle has what’s called a refined bevel cut (see image)—which means that instead of pushing through the skin, like a traditional needle’s “pencil tip” design, it cuts through. This increased sharpness together with a proprietary reduced-friction “white” coating allows the needle to glide into the skin quicker and with less resistance.
Whatever solutions you choose, your patients will surely appreciate your understanding and your efforts to help. And it just might improve their attendance as well.