After an annual physical a few years ago, my doctor recommended blood work. While this is an entirely normal thing for patients to do once in a while, I tend to turn even the most minute task into a Process. This was no different.
I’ve been told on more than one occasion that my veins are some combination of “slippery,” “little” and “buggers.” These comments all mean the same thing — that my veins are difficult to hit — and typically culminate in a digging expedition, usually in both arms, until the phlebotomist finds a well that hasn’t run dry. In the meantime, my cottonmouth escalates to panting and my clammy palms sweat profusely. Eventually, unconsciousness sets in.
It’s safe to say I struggle with needles. A lot of people, in fact, react viscerally to the sight of a phlebotomist armed with a sterile syringe: In one 2009 study, 22 percent of patients surveyed at a primary care practice in Australia reported a fear of needles. Other research estimated that about 63 percent of children and 24 percent of adults are scared of needle procedures, including vaccinations and blood tests. This aversion can result in patients avoiding medical care altogether.
The distress usually manifests in a few ways. Intense fear and anxiety are par for the course; sometimes there’s also fainting. The fainting component, caused by a sudden drop in blood pressure (vasovagal syncope), can be genetic.
Dr. Amy Baxter, a pediatric emergency physician and pain researcher, determined that some cases of needle fear can be traced back to a traumatic childhood event. The more vaccines a child between the ages of 4 and 6 received in a single medical visit, Baxter found, the more likely they were to report a fear of needles five years down the line.
Reactions from parents and doctors also contribute to needle fears in kids. If a doctor, for instance, claims that a needle “won’t hurt a bit” and then that needle does hurt a bit, the child might lose trust in the pro holding it. Additionally, if parents are nervous, children can absorb their anxiety.
As a result, subsequent vaccinations or blood draws can be met with fear — fear of the procedure and fear of the pain. “Fear is like ramping up the volume on your alarm system,” Baxter says. “People perceive more pain when they have fear.”
The good news is that we don’t have to live with fear and pain forever. Here are a few expert-approved tips to help patients young and old cope with needles.
Figure out what you’re really afraid of
A fear of needles could be related to pain, the sight of blood, the prospect of a foreign material entering your body or, in my case, passing out. “Another person might be afraid because they’re not sure of the different steps of the procedure,” says C. Meghan McMurtry, a clinical psychologist at the University of Guelph. “There can be different reasons you’re afraid, so the treatment needs to determine what it is you’re afraid of.”
Do you need pain-management skills? Exposure-based therapy? Physical exercises to keep blood flowing? Getting to the root of the fear is the first part of managing it.
Increase your exposure
Becoming familiar with needles, even if that means bingeing House, MD, can help normalize them. For those with extreme fear, experts suggest an exposure therapy regimen in which a professional slowly introduces the patient to needles. This process should begin with more abstract methods, like exposing the patient to photos of the fear source. “If someone was really afraid of the look of the needle, we might show them pictures in a book,” McMurtry says, “eventually graduating to sitting close to a needle.”
Baxter says that real-life needle experiences should get easier once a patient has endured three not-so-great needle scenarios.
Lessen the pain
Let’s face it: No one really likes getting a shot. It hurts. People who only have moderate anxiety over needle pain, or who’ve already accepted their fear and increased their needle exposure, can use pain-management methods to make the process more tolerable.
“There’s a tendency in our culture to say, ‘No pain, no gain,’ ‘It’s just a little pinch,’” McMurtry notes. “It’s not particularly helpful. There’s no reason you need to feel significant pain from a needle procedure. If we managed pain from the get-go, we probably would have many fewer adults afraid of needles.”
One easy pain suppressant is a topical anesthetic, applied 30 to 45 minutes before the needle breaks skin. Baxter has also developed a product called Buzzy. The bee-shaped tool, which can be used by children and adults, vibrates while simultaneously emitting cold. This helps block pain by confusing nerves at the injection site.
Whichever method of pain management you prefer, McMurtry stresses the importance of self-advocacy. If you want topical anesthetics, go ahead and lather some on. If you just want to look away while blood is being drawn, that’s your prerogative. “Everyone deserves management of pain from needles,” she says. “If someone has a really high level of needle fear, you need a different approach from someone who doesn’t have such a high level.”
This goes beyond just looking away from your arm during the procedure, though that helps too. If you can focus on another task, such as counting the number of panels on the ceiling or answering a series of simple math problems prompted by a friend, then you’ll be less likely to feel the pain. “The focus part is really important because, while you’re getting the injection or the needle or the IV, the more you pay attention to that, the more it hurts,” Baxter says.
The key is to make sure the distraction task can be completed in between five and 15 seconds. A simple “How many fingers am I holding up?” is too easy, whereas attempting to find Waldo is too hard. During a recent visit, Baxter’s son counted the number of confetti specks in a tile on the floor of the doctor’s office.
Tense your muscles
For anyone who passes out, it’s especially important to keep blood pressure up. McMurtry suggests continuously flexing the leg and stomach muscles for 10- to 15-second intervals, interspersed by brief releases. Baxter mentions “giving yourself a handshake” and pulling your arms in opposite directions. “That move increases the amount of blood that goes into your heart temporarily,” she says.
Before a needle procedure, Baxter recommends drinking 16 ounces of water or a caffeinated beverage, which can help keep blood pressure raised.
Talk to the staff
No medical professional will judge you for freaking out at the sight of a syringe. “A lot of people have mistakenly thought that you don’t want to draw attention to it or ask about it,” Baxter says. “That increases the shame. It doesn’t help mitigate the problem.” Instead, if doctors and nurses are aware of your fear, especially if you get lightheaded, they’re more likely to accommodate your needs by suggesting you lie down.
Being open to communication and setting reasonable expectations are part of the process too. “Certainly we don’t tell people it’s not going to hurt at all,” she says, Then if it does, you’ve lost any kind of credibility. It’s important to be realistic.”