Needle phobia, trypanophobia, “Blood injection injury phobia”, and balanophobia all can cause an extreme fear of medical procedures involving injections or needles. For most people who have this fear, it develops around age 4 or 5 with a bad immunization experience.
Additionally, about 3-5% of women and 1-2% of men have a genetic predisposition to getting light-headed or fainting (ie vasovagal syncope) in response to needle procedures. While this can lead to an avoidance or fear of needles, it starts out as physiologic response first.
Similarly, a 2012 survey by Target found 23% of those who didn’t get a flu shot avoided it because of the needle.
For children, the incidence changed from 25% in 1995 to 63% in 2012 — 252% increase in less than 2 decades.
Needle phobia can have some disturbing side effects. Our NIH research showed children with high needle fear were 2.5x less likely to complete their HPV series than those with low fear. Fear of needles is a barrier to health.
are non-compliant with vaccines due to needle phobia. (Taddio 2012)
Protecting anyone from life-long needle phobia must start from their first memorable experiences with needles. Even with children who are pre-disposed to fainting, other factors play an important role in the development of a health-threatening phobia.
If parents and professionals intervene early on in children’s lives, it can help protect them from developing this health-threatening condition. The more vaccines we give in early childhood, the more opportunities for traumatic memory and association with doctors. As we add more vaccines, we MUST add protective ways of decreasing the negative reaction to healthcare.
Needle pain management is one of the most effective interventions. During the first encounters with needles, needle pain management and distraction can protect the child from traumatic experience associated with medical procedures and the clinical environment and experience, and prevent the child from developing anxiety and even phobia later in her life.
The best interventions deal with both pain directly as well as fear and focus. Learning to distract oneself from pain is a lifelong coping strategy.
According to clinical research, Buzzy® Pain Relief can reduce IV needle pain by 80%; some studies have looked at both pain and fear. Used with DistrACTION® Cards, Buzzy® can almost completely eliminate pain (down to 0.53 on a 10 point scale, Inal S.). The physiology of cold and vibration, called Gate Control, naturally blocks out the competing stimulation of pain. Controlling as many aspects of a medical visit as possible is one way to control your fear of needles.
As a byproduct of developing Buzzy, Dr. Baxter discovered the abrupt rise in needle fear, and constructed the multimodal model of pain/fear/focus reduction to comprehensively address the problem. In addition to TEDx and TEDMED talks about the causes and consequences of needle phobia, Dr. Baxter presents research on the subject and writes scholarly articles. Contact us directly if you are interested in the subject, have a solution to share, or plan a research study.
Dr. Anna Taddio and her group in Canada do a marvelous job of creating guidelines for improving vaccination pain(1) every 5 years. Previously the research was based on IV access studies. It is now known that injections are approximately twice as painful as IV, so a different research base is being used. Buzzy has the most injection proof of any intervention. For children, breathing with a toy or bubbles, verbal video, and music distraction have weak research support. As of 2021, here is the most current data on reducing vaccine pain and fear for the 4+ age range. These children are old enough to remember, so reducing medical trauma matters to their future independent uptake of healthcare. Many of these techniques are applicable to adults, too.
Pain, expected pain, and fear are highly correlated.(2, 3) Addressing both pain and fear is synergistic for relief – more than the sum of its parts.(4, 5) To prevent or treat most needle anxiety, addressing both pain and fear while changing the focus during a procedure is the best practice
Cold and vibration reduced pain 70% in 41 4-6 year olds;(12) simultaneous vibration + cold (Buzzy) reduced injection pain 40% in 50 3 – 18 year olds;(13) another study found Buzzy reduced pain 74% in 104 7 year olds receiving a TDaP;(14) and several other studies also show pain reduction for adult flu immunization,(15) Diclofenac by 74% for adults,(16) and Bicillin by 50%.(17)
The most groundbreaking new work here is the degree to which parents influence their young child’s fear. Campbell and Pillai at York University have followed preschool children’s behaviors during vaccines since birth, and found that “caregiver behaviors during vaccinations are … critical to both child pain coping responses and outcomes in the short- and long-term.”(18) For older kids, multiple studies and two meta-analyses show that Buzzy reduces injection anxiety.(19) To best control fear, though, since post-traumatic stress is heavily influenced by parent’s signals,(20) parents need to get a grip. Tips: be warm but no-nonsense, and praise the child’s effort at coping while reinforcing that vaccines keep them safe.
While a few studies incorporate blowing bubbles as distractions for lab draws, quality fear data for immunizations is scant. In multiple studies, DistrACTION cards (visual cards requiring a task) reduced venipuncture anxiety more than blowing a balloon, kaleidoscopes, or watching a video.(21) Compared to nothing, 97% reported a better experience than previous with DistrACTION cards, but this was for 7-10 year olds undergoing venipuncture.(22)
Overall, the most current review of immunization pain and anxiety reduction concluded, “Interventions using coolant and vibration together, as well as a combination of site-specific and patient-led interventions, showed the most consistent effects in reducing self-reported pain, fear or distress.”(23)
We do know that active distraction is better than passive, but there currently is not evidence to recommend bubbles over DistrACTION cards or Virtual Reality – probably iPad research will end up being the best. We really need to know.
For adults already afraid, using a pain reliever reduces fear by half after three experiences. Adding distraction probably helps more, or faster, but hasn’t been studied. Tips for teens actually often work well for adults.
Amy Baxter MD has been a fellow of the American Academy of Pediatrics and the American College of Emergency Physicians, and is a Clinical Associate Professor of Emergency Medicine at the Medical College of Georgia Augusta University. Since 2016 she has been the full time CEO of Pain Care Labs, making external neuromodulatory over the counter pain relief devices Buzzy and VibraCool. She has advocated for humane vaccination with ZDoggMD, at TEDx and discussed her research at TEDMED talks, among others. To date, Buzzy has been used to block pain from over 37 million needle procedures.
Taddio, Ipp et al. Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine 2012;30(32):4807-12
ARmfield, J The extent and nature of dental fear and phobia in Australia. Aust Dent J 2011;55(5):368-77
Wright, Yelland et al. Fear of needles–nature and prevalence in general practice. Aust Fam Physician 2009;38(3):172-6