Dr Deborah Lee, Dr Fox Online Pharmacy, explores what can be done to help patients who refuse the COVID-19 vaccination due to needle phobia
I remember seeing a young male patient in a Sexual Health Clinic some years ago. I just casually mentioned he might need a blood test and the next thing I knew he was flat out on the floor! I hadn’t even shown him a syringe or a needle – the mere mention of the possible need for a blood test was enough for him to spark out!
This is true ‘needle phobia’ – an extreme fear of needles, which cannot be overcome by rational explanation, and is so serious that it stops patients from having the tests and the treatments they need.
At the present time, we are trying to vaccinate the whole country against COVID-19, and those with needle phobia will be at a great disadvantage. Even hearing regular news broadcasts about the need for vaccination will induce fear and panic.
Needle phobics are a group likely to refuse the COVID vaccination, which after all, involves not just one jab, but two.
What can be done to help needle phobics at this crucial time?
What is needle phobia?
Needle phobia has a proper medical name – trypanophobia. It’s a recognised psychiatric condition, where an irrational fear of being pricked by a needle induces severe feelings of dread and anxiety.
Even the thought of an impending procedure which requires venepuncture, induces an acute anxiety response, or a panic attack – a rapid heart rate, faster breathing, sweating, and a drop in blood pressure. The result, not infrequently, is a syncopal episode – fainting and collapse.
Sufferers may fear a vasovagal fainting episode such as they have had in the past, even more than the needle procedure itself.
Those with needle phobia can also develop a fear of being controlled and can become aggressive when challenged. When we hear people arguing against the vaccine, I wonder how many of them are needle phobics.
How common is needle phobia?
Between 3-10% of UK adults suffer from needle phobia (Anxiety UK). Needle phobia is most commonly seen in children but often continues into adulthood. A 2018 meta-analysis, which included 119 research studies, reported needle phobia in almost all children, 20-50% of adolescents, and 20-30% of young people.
Why does needle phobia matter?
Having a fear of needles can have serious, negative, health consequences.
Being needle phobic can deter someone from having blood tests, accepting a blood transfusion, becoming a blood donor, having urgent surgery, or accepting a range of healthcare options including vaccinations, contraceptive injections, and implants. Insulin dependant diabetics have considerable difficulty if they suffer from needle phobia.
5-15% of the population avoid the dentist due to fear of needing a dental injection. A fear of needles can also affect education, the ability to travel, pregnancy outcome and can result in legal issues.
Overall, 16% of adults refuse flu injections because of needle phobia. 27% of hospital employees, 18% of those working in long term care institutions and 8% of healthcare workers, refuse a flu vaccination due to needle phobia.
Why do some people develop needle phobia?
The cause of needle phobia may never be discovered. However, 80% of those affected have a first-degree relative who suffers from the same condition. It may be this is a learned response.
Sometimes, needle phobia may develop following a long period of illness such as treatment for childhood cancer, or witnessing a close relative go through a protracted period of medical care.
There may be genetic differences in people’s perception of pain, meaning some experience far more pain than others being pricked by a needle. Interestingly, needle phobia is more common in monozygotic than in dizygotic twins.
Some have suggested the fear of needles is a primitive response which evolved to help people avoid injuries such as stab wounds, which would have been fatal.
What to do about needle phobia?
Healthcare professionals need to realise the importance of needle phobia. It can be frustrating in a busy clinic to find a patient with needle phobia. However, this needs to be treated with patience and kindness. Let’s remember that pain management is a human right.
Now, amid the COVID-29 pandemic, is a perfect time to address this problem, help patients overcome their fears, and improve their opportunities for healthcare in the future.
- Explain the ‘fight, fright, and flight’ mechanism of anxiety. This is a normal physiological response. However, the patient can learn to control it.
- Teach the patient how to perform diaphragmatic breathing. They can be doing this at home before their venepuncture appointment, outside in the waiting room, and even during the procedure.
- We can all learn to control our thoughts and emotions. For example, fix your gaze on an object in the room and study it carefully. Focus on that object and don’t allow your mind to wander.
- Think positive thoughts … ‘I can do this … I will do this …’ not negative thoughts.
Patients can be referred to the Psychology Team for further help. The technique employed is often to break the process of venepunctures into a series of small steps –
- Look at a needle.
- Hold a needle in your hand.
- Inject an orange with water.
- Watch someone having an injection on TV.
- Watch another person having an injection.
- Have an injection.
Managing needle phobia
Managing anxiety sometimes requires anti-anxiety medication – beta-blockers, serotonin or noradrenaline reuptake inhibitors (SSRI’s, SNRI’s), benzodiazepines, or pregabalin.
In the short term, if venepuncture is needed, the patient may benefit from the use of Emla cream which can be applied one hour before the procedure. Some may need a single dose of diazepam.
There are a variety of free – NHS apps available for anxiety.
Needle phobia is a serious condition which deserves attention. By recognising this, and helping patients receive appropriate help, we can help improve their health care and life choices, now and in the future. If patients are refusing the COVID-19 vaccination due to needle phobia, now is the time to take action.
Overcoming needle phobia is vital for a fully successful COVID-19 vaccination campaign.
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