Fear of needles

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Fear of needles
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A man being assuaged in order to receive an injection due to a fear of needles
TreatmentExposure-based therapies and alternate forms of clinical inoculation
FrequencyAbout 22% of adult population, 3.5–10% of general population may temporarily lose consciousness around the time of a needle procedure

Fear of needles, known in medical literature as needle phobia, is the extreme fear of medical procedures involving injections or hypodermic needles. This can lead to avoidance of medical care and vaccine hesitancy.

Contents

It is occasionally referred to as aichmophobia , although this term may also refer to a more general fear of sharply pointed objects.

Overview and incidence

The condition was officially recognized in 1994 in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) as a specific phobia of blood-injection-injury type phobia (BII phobia). Phobic level responses to injections cause sufferers to avoid inoculations, blood tests, and in the more severe cases, all medical care.

It is estimated that at least 10% of American adults have a fear of needles, and it is likely that the actual number is larger, as the most severe cases are never documented due to the tendency of the sufferer to avoid all medical treatment. [1] The diagnosis criteria for BII phobias are stricter, with an estimated 3-4% prevalence in the general population, and this also includes blood-related phobias. [2]

Prevalence of fear of needles has been increasing, with two studies showing an increase among children from 25% in 1995 to 65% in 2012 (for those born after 1999). [3] Augusta University professor Amy Baxter attributes this increase to an increase in administration of booster shots around the age of 5, which is old enough to remember and young enough to be more likely to result in formation of a phobia. [3]

Evolutionary basis

According to Dr. James G. Hamilton, author of the pioneering paper on needle phobia, it is likely that the form of needle phobia that is genetic has some basis in evolution, given that thousands of years ago humans who meticulously avoided stab wounds and other incidences of pierced flesh would have a greater chance of survival. [1]

The discussion of the evolutionary basis of needle phobia in Hamilton's review article concerns the vasovagal type of needle phobia, which is a sub-type of blood-injection-injury type phobia. This type of needle phobia is uniquely characterized by a two-phase vasovagal response. [4] First, there is a brief acceleration of heart rate and blood pressure. This is followed by a rapid plunge in both heart rate and blood pressure, sometimes leading to unconsciousness. [1] [4] The loss of consciousness is sometimes accompanied by convulsions and numerous rapid changes in the levels of many different hormones. [1] [5]

Other medical journal articles have discussed additional aspects of this possible link between vasovagal syncope and evolutionary fitness in blood-injection-injury phobias. [6]

An evolutionary psychology theory that explains the association to vasovagal syncope is that some forms of fainting are non-verbal signals that developed in response to increased inter-group aggression during the paleolithic. A non-combatant who has fainted signals that they are not a threat. [7] This might explain the association between fainting and stimuli such as bloodletting and injuries.

Types

Although needle phobia is defined simply as an extreme fear of medically related shots/injections, it appears in several varieties.

Vasovagal

Although most specific phobias stem from the individuals themselves, the most common type of needle phobia, affecting 50% of those afflicted, is an inherited vasovagal reflex reaction. Approximately 80% of people with a fear of needles report that a relative within the first degree exhibits the same disorder. [8]

Vasovagal reactions may be triggered by the sight, thought, or feeling of needles or needle-like objects. The physiological changes associated with this type of phobia also include feeling faint, sweating, dizziness, nausea, pallor, tinnitus, panic attacks, and initially high blood pressure and heart rate followed by a plunge in both at the moment of injection. The primary symptom of vasovagal fear is vasovagal syncope, or fainting due to a decrease of blood pressure.

Many people who suffer from fainting during needle procedures report no conscious fear of the needle procedure itself, but a great fear of the vasovagal syncope reaction. People become more afraid of the side effects of low blood pressure caused by the idea of a needle. [9]

A study in the medical journal Circulation concluded that in many patients with this condition (as well as patients with the broader range of blood/injury phobias), an initial episode of vasovagal syncope during a needle procedure may be the primary cause of needle phobia rather than any basic fear of needles. [10] These findings reverse the more commonly held beliefs about the cause-and-effect pattern of needle phobics with vasovagal syncope.

Although most phobias are dangerous to some degree, needle phobia is one of the few that actually kill. In cases of severe phobia, the drop in blood pressure caused by the vasovagal shock reflex may cause death. In Hamilton's 1995 review article on needle phobia, he was able to document 23 deaths as a direct result of vasovagal shock during a needle procedure. [1]

The best treatment strategy for this type of needle phobia has historically been desensitization or the progressive exposure of the patient to gradually more frightening stimuli, allowing them to become desensitized to the stimulus that triggers the phobic response.  In recent years, a technique known as "applied tension" has become increasingly accepted as an often effective means for maintaining blood pressure to avoid the unpleasant, and sometimes dangerous, aspects of the vasovagal reaction. [11] [12] [13]

Associative

Associative fear of needles is the second most common type, affecting 30% of needle phobics. This type is the classic specific phobia in which a traumatic event such as an extremely painful medical procedure or witnessing a family member or friend undergo such, causes the patient to associate all procedures involving needles with the original negative experience.

This form of fear of needles causes symptoms that are primarily psychological in nature, such as extreme unexplained anxiety, insomnia, preoccupation with the coming procedure, and panic attacks. Effective treatments include cognitive therapy, hypnosis, and/or the administration of anti-anxiety medication.

Resistive

Resistive fear of needles occurs when the underlying fear involves not simply needles or injections but also being controlled or restrained. It typically stems from repressive upbringing[ citation needed ] or poor handling of prior needle procedures (for example, forced physical or emotional restraint).

This form of needle phobia affects around 20% of those afflicted. Symptoms include combativeness, high heart rate coupled with extremely high blood pressure, violent resistance, avoidance, and flight. The suggested treatment is psychotherapy, this may include teaching the patient self-injection techniques or finding a trusted health care provider.

Hyperalgesic

Hyperalgesic fear of needles is another form that does not have as much to do with fear of the actual needle. Patients with this form have an inherited hypersensitivity to pain, or hyperalgesia. To them, the pain of an injection is unbearably great and many cannot understand how anyone can tolerate such procedures.

This form of fear of needles affects approximately 10% of people with needle phobia. The symptoms include extreme explained anxiety,[ clarification needed ] and elevated blood pressure and heart rate at the immediate point of needle penetration or seconds before. The recommended forms of treatment include some form of anesthesia, either topical or general.

Vicarious

Whilst witnessing procedures involving needles it is possible for the phobic to suffer the symptoms of a needle phobic attack without actually being injected. Prompted by the sight of the injection the phobic may exhibit the normal symptoms of vasovagal syncope and fainting or collapse is common. While the cause of this is not known, it may be due to the phobic imagining the procedure being performed on themselves. Recent neuroscience research shows that feeling a pin prick sensation and watching someone else's hand get pricked by a pin activate the same part of the brain. [14]

Comorbidity and triggers

Fear of needles, especially in its more severe forms, is often comorbid with other phobias and psychological ailments; for example, iatrophobia, or an irrational fear of doctors, is often seen in needle phobic patients.

A needle phobic patient does not need to physically be in a doctor's office to experience panic attacks or anxiety brought on by needle phobia. There are many triggers in the outside world that can bring on an attack through association. Some of these are blood, injuries, the sight of the needle physically or on a screen, paper pins, syringes, examination rooms, white lab coats, dentists, nurses, the antiseptic smell associated with offices and hospitals, the sight of a person who physically resembles the patient's regular health care provider, or even reading about the fear.

Treatment, mitigation, and alternatives

Medical literature suggests a number of treatments that have been proven effective for specific cases of needle phobia, but provides very little guidance to predict which treatment may be effective for any specific case. The following are some of the treatments that have been shown to be effective in some specific cases.

See also

Related Research Articles

<span class="mw-page-title-main">Phobia</span> Anxiety disorder classified by a persistent and excessive fear of an object or situation

A phobia is an anxiety disorder, defined by an irrational, unrealistic, persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the object or situation cannot be avoided, they experience significant distress. Other symptoms can include fainting, which may occur in blood or injury phobia, and panic attacks, often found in agoraphobia and emetophobia. Around 75% of those with phobias have multiple phobias.

<span class="mw-page-title-main">Local anesthetic</span> Medications to reversibly block pain

A local anesthetic (LA) is a medication that causes absence of all sensation in a specific body part without loss of consciousness, providing local anesthesia, as opposed to a general anesthetic, which eliminates all sensation in the entire body and causes unconsciousness. Local anesthetics are most commonly used to eliminate pain during or after surgery. When it is used on specific nerve pathways, paralysis also can be induced.

<span class="mw-page-title-main">Venipuncture</span> Process of obtaining intravenous access

In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of venous blood sampling or intravenous therapy. In healthcare, this procedure is performed by medical laboratory scientists, medical practitioners, some EMTs, paramedics, phlebotomists, dialysis technicians, and other nursing staff. In veterinary medicine, the procedure is performed by veterinarians and veterinary technicians.

<span class="mw-page-title-main">Lidocaine</span> Local anesthetic

Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidocaine typically begins working within several minutes and lasts for half an hour to three hours. Lidocaine mixtures may also be applied directly to the skin or mucous membranes to numb the area. It is often used mixed with a small amount of adrenaline (epinephrine) to prolong its local effects and to decrease bleeding.

Paresthesia is an abnormal sensation of the skin with no apparent physical cause. Paresthesia may be transient or chronic, and may have many possible underlying causes. Paresthesias are usually painless and can occur anywhere on the body, but most commonly occur in the arms and legs.

Lidocaine/prilocaine is a eutectic mixture of equal quantities of lidocaine and prilocaine. A 5% emulsion preparation, containing 2.5% each of lidocaine/prilocaine, is marketed by APP Pharmaceuticals under the trade name EMLA. As a spray, it is marketed under the name Tempe (PSD502) that can be used by men to help with premature ejaculation. The spray is manufactured by Plethora Solutions and branded as Fortacin in the UK and Recordati in the EU.

<span class="mw-page-title-main">Injection (medicine)</span> Method of medication administration

An injection is the act of administering a liquid, especially a drug, into a person's body using a needle and a syringe. An injection is considered a form of parenteral drug administration; it does not involve absorption in the digestive tract. This allows the medication to be absorbed more rapidly and avoid the first pass effect. There are many types of injection, which are generally named after the body tissue the injection is administered into. This includes common injections such as subcutaneous, intramuscular, and intravenous injections, as well as less common injections such as intraperitoneal, intraosseous, intracardiac, intraarticular, and intracavernous injections.

<span class="mw-page-title-main">Reflex syncope</span> Brief loss of consciousness due to a neurologically induced drop in blood pressure

Reflex syncope is a brief loss of consciousness due to a neurologically induced drop in blood pressure and/or a decrease in heart rate. Before an affected person passes out, there may be sweating, a decreased ability to see, or ringing in the ears. Occasionally, the person may twitch while unconscious. Complications of reflex syncope include injury due to a fall.

Infiltration analgesia is deposition of an analgesic drug close to the apex of a tooth so that it can diffuse to reach the nerve entering the apical foramina. It is the most routinely used in dental local treatment.

<span class="mw-page-title-main">Nerve block</span> Deliberate inhibition of nerve impulses

Nerve block or regional nerve blockade is any deliberate interruption of signals traveling along a nerve, often for the purpose of pain relief. Local anesthetic nerve block is a short-term block, usually lasting hours or days, involving the injection of an anesthetic, a corticosteroid, and other agents onto or near a nerve. Neurolytic block, the deliberate temporary degeneration of nerve fibers through the application of chemicals, heat, or freezing, produces a block that may persist for weeks, months, or indefinitely. Neurectomy, the cutting through or removal of a nerve or a section of a nerve, usually produces a permanent block. Because neurectomy of a sensory nerve is often followed, months later, by the emergence of new, more intense pain, sensory nerve neurectomy is rarely performed.

Blood phobia is an extreme irrational fear of blood, a type of specific phobia. Severe cases of this fear can cause physical reactions that are uncommon in most other fears, specifically vasovagal syncope (fainting). Similar reactions can also occur with trypanophobia and traumatophobia. For this reason, these phobias are categorized as blood-injection-injury phobia by the DSM-IV. Some early texts refer to this category as "blood-injury-illness phobia."

Veterinary anesthesia is a specialization in the veterinary medicine field dedicated to the proper administration of anesthetic agents to non-human animals to control their consciousness during procedures. A veterinarian or a Registered Veterinary Technician administers these drugs to minimize stress, destructive behavior, and the threat of injury to both the patient and the doctor. The duration of the anesthesia process goes from the time before an animal leaves for the visit to the time after the animal reaches home after the visit, meaning it includes care from both the owner and the veterinary staff. Generally, anesthesia is used for a wider range of circumstances in animals than in people not only due to their inability to cooperate with certain diagnostic or therapeutic procedures, but also due to their species, breed, size, and corresponding anatomy. Veterinary anesthesia includes anesthesia of the major species: dogs, cats, horses, cattle, sheep, goats, and pigs, as well as all other animals requiring veterinary care such as birds, pocket pets, and wildlife.

Dental anesthesia is the application of anesthesia to dentistry. It includes local anesthetics, sedation, and general anesthesia.

<span class="mw-page-title-main">Dental fear</span> Medical condition

Dental fear, or dentophobia, is a normal emotional reaction to one or more specific threatening stimuli in the dental situation. However, dental anxiety is indicative of a state of apprehension that something dreadful is going to happen in relation to dental treatment, and it is usually coupled with a sense of losing control. Similarly, dental phobia denotes a severe type of dental anxiety, and is characterised by marked and persistent anxiety in relation to either clearly discernible situations or objects or to the dental setting in general. The term ‘dental fear and anxiety’ (DFA) is often used to refer to strong negative feelings associated with dental treatment among children, adolescents and adults, whether or not the criteria for a diagnosis of dental phobia are met. Dental phobia can include fear of dental procedures, dental environment or setting, fear of dental instruments or fear of the dentist as a person. People with dental phobia often avoid the dentist and neglect oral health, which may lead to painful dental problems and ultimately force a visit to the dentist. The emergency nature of this appointment may serve to worsen the phobia. This phenomenon may also be called the cycle of dental fear. Dental anxiety typically starts in childhood. There is the potential for this to place strains on relationships and negatively impact on employment.

<span class="mw-page-title-main">Syncope (medicine)</span> Transient loss of consciousness and postural tone

Syncope, commonly known as fainting or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain, typically from low blood pressure. There are sometimes symptoms before the loss of consciousness such as lightheadedness, sweating, pale skin, blurred vision, nausea, vomiting, or feeling warm. Syncope may also be associated with a short episode of muscle twitching. Psychiatric causes can also be determined when a patient experiences fear, anxiety, or panic; particularly before a stressful event, usually medical in nature. When consciousness and muscle strength are not completely lost, it is called presyncope. It is recommended that presyncope be treated the same as syncope.

Blood-injection-injury (BII) type phobia is a type of specific phobia characterized by the display of excessive, irrational fear in response to the sight of blood, injury, or injection, or in anticipation of an injection, injury, or exposure to blood. Blood-like stimuli may also cause a reaction. This is a common phobia with an estimated 3-4% prevalence in the general population, though it has been found to occur more often in younger and less educated groups. Prevalence of fear of needles which does not meet the BII phobia criteria is higher. A proper name for BII has yet to be created.

Most people have a fear of medical procedures at some point in their lifetime, which can include the fear of surgery, dental work, doctors, or needles. These fears are seldom diagnosed or treated, as they are often extinguished into adulthood and do not often develop into phobias preventing individuals from seeking medical attention. Formally, medical fear is defined as "any experience that involves medical personnel or procedures involved in the process of evaluating or modifying health status in traditional health care settings."

<span class="mw-page-title-main">Microneedle drug delivery</span>

Microneedles or Microneedle patches or Microarray patches are micron-scaled medical devices used to administer vaccines, drugs, and other therapeutic agents. While microneedles were initially explored for transdermal drug delivery applications, their use has been extended for the intraocular, vaginal, transungual, cardiac, vascular, gastrointestinal, and intracochlear delivery of drugs. Microneedles are constructed through various methods, usually involving photolithographic processes or micromolding. These methods involve etching microscopic structure into resin or silicon in order to cast microneedles. Microneedles are made from a variety of material ranging from silicon, titanium, stainless steel, and polymers. Some microneedles are made of a drug to be delivered to the body but are shaped into a needle so they will penetrate the skin. The microneedles range in size, shape, and function but are all used as an alternative to other delivery methods like the conventional hypodermic needle or other injection apparatus.

Shoulder injury related to vaccine administration (SIRVA) is "shoulder pain and limited range of motion occurring after the administration of a vaccine intended for intramuscular administration in the upper arm... thought to occur as a result of unintended injection of vaccine antigen or trauma from the needle into and around the underlying bursa of the shoulder".

References

  1. 1 2 3 4 5 6 James G. Hamilton (August 1995). "Needle Phobia - A Neglected Diagnosis". Journal of Family Practice. 41 (2): 169–175 REVIEW. PMID   7636457.
  2. ↑ Wani, Ab Latif; Ara, Anjum; Bhat, Sajad Ahmad (2014). "Blood Injury and Injection Phobia: The Neglected One". Behavioural Neurology. 2014: 471340. doi: 10.1155/2014/471340 . PMC   4094700 . PMID   25049451.
  3. 1 2 3 4 5 Amy Baxter (11 June 2021). "Over half of adults unvaccinated for COVID-19 fear needles – here's what's proven to help". The Conversation .
  4. 1 2 "Oxford Textbook of Psychopathology" by Theodore Millon, Paul H. Blaney, Roger D. Davis (1999) ISBN   0-19-510307-6, p. 82
  5. ↑ Ellinwood, Everett H.; Hamilton, James G. (April 1991). "Case report of a needle phobia". Journal of Family Practice. 32 (4): 420–422. PMID   2010743.
  6. ↑ Rolf R. Diehl (April 2005). "Vasovagal syncope and Darwinian fitness". Clinical Autonomic Research. 15 (2): 126–129. doi:10.1007/s10286-005-0244-0. PMID   15834770. S2CID   2062277.
  7. ↑ Bracha, H. (2006). "Human brain evolution and the "Neuroevolutionary Time-depth Principle:" Implications for the Reclassification of fear-circuitry-related traits in DSM-V and for studying resilience to warzone-related posttraumatic stress disorder" (PDF). Progress in Neuro-Psychopharmacology and Biological Psychiatry. 30 (5): 827–853. doi:10.1016/j.pnpbp.2006.01.008. PMC   7130737 . PMID   16563589.
  8. ↑ Jenkins, K. (2014-07-01). "II. Needle phobia: a psychological perspective". British Journal of Anaesthesia. 113 (1): 4–6. doi: 10.1093/bja/aeu013 . ISSN   0007-0912. PMID   24574504.
  9. ↑ "How to overcome a fear of needles". wexnermedical.osu.edu. 31 October 2019. Retrieved 2021-05-16.
  10. ↑ Accurso, V.; et al. (August 2001). "Predisposition to Vasovagal Syncope in Subjects With Blood/Injury Phobia". Circulation. 104 (8): 903–907. doi: 10.1161/hc3301.094910 . PMID   11514377.
  11. 1 2 Ost, L.G.; et al. (1991). "Applied tension, exposure in vivo, and tension-only in the treatment of blood phobia". Behaviour Research and Therapy. 29 (6): 561–574. doi:10.1016/0005-7967(91)90006-O. PMID   1684704.
  12. 1 2 Ditto, B.; et al. (2009). "Physiological correlates of applied tension may contribute to reduced fainting during medical procedures". Annals of Behavioral Medicine. 37 (3): 306–314. doi: 10.1007/s12160-009-9114-7 . PMID   19730965. S2CID   3429566.
  13. ↑ Ayala, E.S.; et al. (2009). "Treatments for blood-injury-injection phobia: a critical review of current evidence". Journal of Psychiatric Research. 43 (15): 1235–1242 REVIEW. doi:10.1016/j.jpsychires.2009.04.008. PMID   19464700.
  14. ↑ Morrison, I.; et al. (June 2004). "Vicarious responses to pain in anterior cingulate cortex: is empathy a multisensory issue?". Cognitive, Affective, & Behavioral Neuroscience. 4 (2): 270–278. doi: 10.3758/CABN.4.2.270 . PMID   15460933. [ permanent dead link ]
  15. ↑ Hogan, M.E.; et al. (10 February 2010). "A systematic review of measures for reducing injection pain during adult immunization". Vaccine. 28 (6): 1514–1521. doi:10.1016/j.vaccine.2009.11.065. PMID   20003927.
  16. ↑ Schramm-Baxter, J.R.; Mitragotri, S. (2004). "Investigations of Needle-free Jet Injections". The 26th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. Vol. 4. pp. 3543–3546. doi:10.1109/IEMBS.2004.1403996. ISBN   0-7803-8439-3. PMID   17271055. S2CID   24551858.
  17. ↑ Greenbaum, S.S.; Bernstein, E.F. (September 1994). "Comparison of iontophoresis of lidocaine with a eutectic mixture of lidocaine and prilocaine (EMLA) for topically administered local anesthesia". The Journal of Dermatologic Surgery and Oncology. 20 (9): 579–583. doi:10.1111/j.1524-4725.1994.tb00150.x. PMID   8089357.
  18. ↑ Smith & Nephew. Ametop Gel information Archived 2011-08-01 at the Wayback Machine .
  19. ↑ Arrowsmith, J.; Campbell, C. (2000). "A comparison of local anaesthetics for venepuncture". Archives of Disease in Childhood. 82 (4): 309–310. doi:10.1136/adc.82.4.309. PMC   1718269 . PMID   10735838.
  20. 1 2 Sawyer, James; et al. (February 2009). "Heated lidocaine/tetracaine patch compared with lidocaine/prilocaine cream for topical anaesthesia before vascular access". British Journal of Anaesthesia. 102 (2): 210–215. doi: 10.1093/bja/aen364 . PMID   19151049.
  21. ↑ "Miravo 2022 Q3 Quarterly Report, page 15" (PDF). Nuvo Research d/b/a Miravo Health Care. November 11, 2022. Retrieved December 11, 2022.
  22. ↑ Stewart, J.E. (May 1994). "Diagnosis and treatment of phobia". Professional Nurse. 9 (8): 549–552. PMID   8008769.
  23. ↑ Shabani, D.B.; Fisher, W.W. (Winter 2006). Woods, Douglas W. (ed.). "Stimulus Fading and Differential Reinforcement for the Treatment of Needle Phobia in a Youth with Autism". Journal of Applied Behavior Analysis. 39 (4): 449–552. doi:10.1901/jaba.2006.30-05. PMC   1702338 . PMID   17236343.
  24. ↑ Dental Fear Central. Blood-injury-injection phobia, fainting, and applied tension.
  25. ↑ Amy Baxter (8 June 2020). "Fear of needles could be a hurdle to COVID-19 vaccination, but here are ways to overcome it". The Conversation .
  26. ↑ Pires, A.; Fortuna, A.; Alves, G.; Falcão, A. (2009). "Intranasal drug delivery: How, why and what for?". Journal of Pharmacy & Pharmaceutical Sciences. 12 (3): 288–311. doi: 10.18433/J3NC79 . hdl: 10316/110378 . PMID   20067706.
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