Freakout Free Vaccination Plan
How To Get Immunized Despite Needle Fear
Make A Plan
1. Tell the provider your plan (e.g. “I need to sit, I’m holding her hand, and don’t tell me when you do it.”)
2. Control pain with science-proven interventions.
Studies showing what works for Adult injections: Buzzy:4 EMLA:1 Cold:2 Fake Cough: 1
Studies showing what works for kids: Buzzy 18 Shotblocker 1(insulin only) swearing: 1
3. Fainter? Drink a pint 1 hour before, tense stomach during.
4. Distraction During: Count something!
Pain relief: It’s not just ANY topical anesthetic cream – only EMLA (lidocaine + prilocaine) has been studied for immunizations,(6) with almost all studies in the infant age range. While the creams may have similar efficacy for drawing labs, vaccines hurt more: the studies should be considered separately. Prescription EMLA not only penetrates more deeply than LMX,(7) the effect lasts up to 4 hours, while 4% lidocaine wears off. For pain relief, EMLA must be on at least 60 minutes. There is only one single immunization study in the 4-6 year range using EMLA compared to placebo, and it found 61% pain reduction.(8) A Danish study in 12 year olds found no difference. The infant data should contribute some strength, but in the 4-6 year range the application of creams for an hour can raise anxiety which increases pain.
Vibration - Buzzy alone
Mechanical stimulation in the 200Hz frequency works for lab draws. Since vaccines hurt more, in kids vibration alone did not help(2 – 7 years)(11) For adults, adding 1 minute of M-stim vibration before and after an injection could reduce arm pain, and vibration alone reduces pain. More importantly, Buzzy works best for adults who were anxious about needles. (Redfern et al).
Vibration + Cold - Classic Original Buzzy + Ice Wings
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)
Ice on the spot can help older kids, but sprays get too cold even for adults. In the 4-6 year range, one researcher found cold spray worked as well as a placebo spray (1995), one didn’t,(9) and two other studies also used distraction to address fear and focus, blurring results from spray.(10) Buzzy outperformed cold spray for IVs, with a 3x better success on the first stick.(24)
To help an adult friend control panic to get protected, matter-of-fact empathy helps most. Be prepared to intervene if a caregiver is dismissive, distract while waiting, and help them with their plan, whether hand-holding, having a Tik-tok to show, or coaching deep breaths.
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.
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..
What is Needle Phobia?
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.
Needle Phobia is Growing
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.
7% Adults and 8% of Children
are non-compliant with vaccines due to needle phobia. (Taddio 2012)
22% of Adults
fear needles enough to take risks with their health in regard to vaccinations.
51% of Adults with Type II Diabetesdelay insulin injections due to a fear of needles (Aronson 2015)
94% of AdultsFeel a fear reaction every time they inject. (Aronson 2015)
More life-saving vaccine protection, more pokes.
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.
Age isn't the key driver of needle fear - what matters is birth year.
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.
Distraction mediates both fear and pain in needle procedures. Numerous studies show the effectiveness of distraction in reducing pain and negative emotions during injections.
Physical ways to reduce IV pain include Buzzy®, topical anesthetics, and alternative injection methods like J-Tip. For injections, Buzzy is the most studied and effective, and the only intervention that reduces fear. For a breakdown of these methods for adults, Dr. Baxter testified to HHS Vaccine Advisory Committee in 2021.
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.
How Pain Care Labs Addresses Needle Phobia
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.
A referenced scientific guide on how to deal with needle pain and fear.
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.
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 A, McMurtry CM, Shah V, et al. Reducing pain during vaccine injections: clinical practice guideline. Cmaj. 2015 Sep 22;187(13):975-82
- Windich-Biermeier A, Sjoberg I, Dale JC, Eshelman D, Guzzetta CE. Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer. J Pediatr Oncol Nurs. 2007 Jan-Feb;24(1):8-19.
- Cohen LL, Blount RL, Cohen RJ, Schaen ER, Zaff JF. Comparative study of distraction versus topical anesthesia for pediatric pain management during immunizations. Health Psychol. 1999 Nov;18(6):591-8.
- Baxter L. Common office procedures and analgesia considerations. Pediatric clinics of North America. 2013 Oct;60(5):1163-83.
- Inal S, Kelleci M. The Effect of External Thermomechanical Stimulation and Distraction on Reducing Pain Experienced by Children During Blood Drawing. Pediatr Emerg Care. 2017 Sep
- Shah V, Taddio A, McMurtry CM, et al. Pharmacological and Combined Interventions to Reduce Vaccine Injection Pain in Children – a Systematic Review and Meta-Analysis. Clin J Pain. 2015;31((Suppl 10)):S38-S63.
- Irsfeld S, Klement W, Lipfert P. Dermal anaesthesia: comparison of EMLA cream with iontophoretic local anaesthesia. Br J Anaesth. 1993 Sep;71(3):375-8.
- Cassidy KL, Reid GJ, McGrath PJ, Smith DJ, Brown TL, Finley GA. A randomized double-blind, placebo-controlled trial of the EMLA patch for the reduction of pain associated with intramuscular injection in four to six-year-old children. Acta Paediatr. 2001 Nov;90(11):1329-36.
- Cohen LL, MacLaren JE, DeMore M, et al. A randomized controlled trial of vapocoolant for pediatric immunization distress relief. Clin J Pain. 2009 Jul-Aug;25(6):490-4.
- Cohen Reis E, Holubkov R. Vapocoolant spray is equally effective as EMLA cream in reducing immunization pain in school-aged children. Pediatrics. 1997 Dec;100(6):E5.
- Benjamin AL, Hendrix TJ, Woody JL. Effects of Vibration Therapy in Pediatric Immunizations. Pediatr Nurs. 2016 May-Jun;42(3):124-9; discussion 30.
- Berberich FR, Landman Z. Reducing immunization discomfort in 4- to 6-year-old children: a randomized clinical trial. Pediatrics. 2009 Aug;124(2):e203
- Redfern RE, Chen JT, Sibrel S. Effects of Thermomechanical Stimulation during Vaccination on Anxiety, Pain, and Satisfaction in Pediatric Patients: A Randomized Controlled Trial. J Pediatr Nurs. 2018 Jan – Feb;38:1-7.
- Canbulat Sahiner N, Inal S, Sevim Akbay A. The effect of combined stimulation of external cold and vibration during immunization on pain and anxiety levels in children. Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses. 2015 Jun;30(3):228-35.
- Redfern RE, Micham J, Seegert S, Chen JT. Influencing Vaccinations: A Buzzy Approach to Ease the Discomfort of a Needle Stick-a Prospective, Randomized Controlled Trial. Pain management nursing : official journal of the American Society of Pain Management Nurses. 2019 Apr;20(2):164-169.
- Sahin M, Eser I. Effect of the Buzzy Application on Pain and Injection Satisfaction in Adult Patients Receiving Intramuscular Injections. Pain management nursing : official journal of the American Society of Pain Management Nurses. 2018 Dec;19(6):645-51.
- Russell K, Nicholson R, Naidu R. Reducing the pain of intramuscular benzathine penicillin injections in the rheumatic fever population of Counties Manukau District Health Board. J Paediatr Child Health. 2014 Feb;50(2):112-7.
- Campbell L, Pillai Riddell R, Cribbie R, Garfield H, Greenberg S. Preschool children’s coping responses and outcomes in the vaccination context: child and caregiver transactional and longitudinal relationships. Pain. 2018 Feb;159(2):314-30.
- Canbulat N, Ayhan F, Inal S. Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain management nursing : official journal of the American Society of Pain Management Nurses. 2015 Feb;16(1):33-9.
- Cobham VE, McDermott B. Perceived parenting change and child posttraumatic stress following a natural disaster. Journal of child and adolescent psychopharmacology. 2014 Feb;24(1):18-23.
- Sahiner NC, Bal MD. The effects of three different distraction methods on pain and anxiety in children. J Child Health Care. 2015 Jun 2.
- Inal S, Kelleci M. Distracting children during blood draw: looking through distraction cards is effective in pain relief of children during blood draw. International journal of nursing practice. 2012 Apr;18(2):210-9.
- Lee VY, Caillaud C, Fong J, Edwards KM. Improving vaccine-related pain, distress or fear in healthy children and adolescents-a systematic search of patient-focused interventions. Human Vaccines & Immunotherapeutics. 2018;14(11):2737-47.
- Baxter AL, Cohen LL et al. An integration of cold and vibration relieves pain in the ED for venipuncture. Pediatr Emerg Care 2011 Dec;27(12):1151-6.
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