If you’re among the 25% of Americans averse to needles, you’re probably not surprised by the COVID-19 immunization stall. Even for those who want to be inoculated, bribes with beer or lottery tickets may not be enough to override anxiety made worse by pervasive images of needles.
Needle fear has increased dramatically since a landmark 1995 study by J.G. Hamilton reported that 10% of adults and 25% of children feared needles. In that paper, adult patients who remembered when their fear began described a stressful needle experience around age 5.
Not surprisingly, needle fear affects how willing teens and adults are to get vaccinated. Health care workers are no exception: A 2018 study found that 27% of hospital employees dodged flu vaccines due to needle fear. And most recently, an April 2021 national survey of 600 not-yet-COVID-19-vaccinated U.S. adults found that 52% reported moderate to severe needle fear.
For children, evidence shows that addressing their fear and pain while distracting them from the procedure is most effective in reducing distress.
While adults are not just big children, combining these concepts with findings from available adult injection studies suggest a few potential interventions.
Pain reduction
Relieving injection pain may reduce needle fear by giving patients a feeling of control.
For example, a group of patients in New Zealand were repeatedly missing their monthly antibiotic injections for rheumatic heart disease. Their doctors created a special clinic, offering either anesthetics, a vibrating cold device or both during the shot.
The interventions in 107 adults reduced pain and fear by 50% after three months. Six months later, half the patients still used the interventions, and the special “missed dose” clinic was no longer needed.
Credit: contributed
Credit: contributed
Specifically for vaccination, applying a vibrating cold device to the injection site a minute prior to injection, then pressing just above the site during injection, relieved pain and improved satisfaction for adults, and was most effective for those with needle fear.
Psychological therapy
Exposure-based therapy involves asking a patient to rank anxiety caused by parts of a procedure, like seeing a picture of a tourniquet or thinking about sharp things, and gradually exposing them to these parts in a controlled environment.
Free self-guided resources are available for fears ranging from flying to spiders. However, none of the three studies testing this approach on adult needle fear showed long-term fear reduction.
One of the studies that taught techniques to reduce fainting, however, was considered a success. Fainting and needle fear are often conflated. While passing out due to injections is more common with anxiety, it is often a genetic response.
Tensing the stomach muscles increases the volume of blood the heart can pump, keeping blood in the brain to prevent lightheadedness during needle procedures.
Planning ahead can help make vaccine day more approachable.
Distraction
Surprisingly, there are no studies on adults using distraction for injections. Two studies, however, have found that pretending to cough reduces pain from blood draws.
Mentally engaging tasks may also help. A visual finding task given to children during intramuscular shots has been shown to reduce pain and fear, with 97% rating the experience more pleasant than previous blood draws. Adults may need a more complicated task, but a similar intervention could work for them as well.
The more, the better
To reduce needle fear, research suggests the more interventions, the better.
A 2018 study summarizing research on vaccine pain concluded that patient-operated cold and vibration devices combined with distraction techniques were most effective. Canada has implemented a practical national needle fear intervention for their vaccine rollout, emphasizing preparing ahead to help make vaccine day more comfortable.
Adults who don’t like needles are in the majority.
Taking control of your vaccination experience may be the best way to combat needle anxiety.
Amy Baxter, M.D., is a physician specializing in pain management and a clinical associate professor of emergency medicine at Augusta University. She wrote this piece for The Conversation, a nonprofit, independent news organization dedicated to unlocking the knowledge of experts for the public good. The Conversation publishes informative articles written by academic experts for the general public and edited by its team of journalists. This story is part of the Solutions Journalism Network, a nonprofit organization dedicated to rigorous reporting about responses to social problems. It originally appeared online here.
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