Fearing the needle

I have no real fear of needles. Being stuck with a needle for a vaccination or a blood sample doesn’t bother me in the slightest. Even a bone marrow biopsy didn’t freak me out, although I wasn’t thrilled about it and would rather not go through it again.

For lots of people, though, the prospect of anything to do with medical needles is fraught with a scariness that goes far beyond the normal apprehension or dislike of being stuck. There’s a name for it: trypanophobia. It’s surprisingly common, affecting an estimated 10 percent of the American population.

We often joke about needle phobia. But for the people who have it, it’s anything but funny. Receiving an injection sends them into a panic. At the sight of a needle they can react with a sudden drop in blood pressure, causing them to faint. In more extreme cases they’ll avoid doctors, dentists and other settings where they might encounter a needle. Sometimes this phobia will lead to a generalized fear of medical and dental providers and a refusal to undergo medical visits of any kind.

(While we’re on this topic, I have been annoyed for years with the news media’s insistence on images of people flinching or grimacing or, worse yet, crying over getting a shot. What is up with this? I don’t expect photos of people doing happy dances while being stabbed with a needle, but why are we reinforcing the fear that this is going to be painful and scary? Now that I’ve gone public with my gripe, maybe this practice will be re-examined.)

As you might guess, people with trypanophobia can be quite resistant to the idea of getting a flu shot. That’s why the introduction six years ago of FluMist, an inhaled form of the influenza vaccine, has frankly been a good thing. It makes vaccination less anxiety-inducing for these people, especially for children. Some researchers, in fact, believe needle phobia might be rooted in painful or frightening experiences with medical needles during childhood, although there’s also some evidence suggesting this phobia is at least partially genetic in origin. I personally know of someone who had a needle break off in his gluteus maximus while receiving a penicillin shot during childhood; the needle had to be extricated with a tweezers. There’s no way this kind of experience wouldn’t be upsetting to a child and remembered long into adulthood.

From the health care professional’s point of view, it can’t be enjoyable trying to jab a child who’s crying and struggling, or having a needle-phobic patient pass out. There’s also the ever-present possibility of needlestick injuries and the risks they pose to health care workers.

Researchers have been working for at least four decades to come up with vaccines that can be administered via a nasal spray versus the traditional shot in the arm. The influenza vaccine, which hit the market in 2003, is the first to be successfully developed. Inhaled versions of vaccines for botulism and for tuberculosis also are being studied, and various nasal-spray vaccines have been introduced in veterinary medicine as well.

The challenge, of course, is to produce an inhaled vaccine that’s at least as effective as the injectable kind. There’s little point in taking the sting out of vaccination if the trade-off is going to be a vaccine that doesn’t perform as well.

Studies among children who received FluMist have found that it is as good or better than traditional vaccine at protecting youngsters from influenza. It seems to work best among children in the 2- to 5-year-old age group.

The jury is still out over whether FluMist works equally well among adults. Most studies to date have produced inconsistent results, with the latest findings suggesting the injected version of the influenza vaccine is more effective for this age group.

To be sure, FluMist has its drawbacks. Because it’s formulated with a weakened live virus, it can’t be used on everyone. So far, it has only been approved for healthy people ages 2-49. Whether this will ever be expanded to those 50 and older is an open question; not enough people older than 49 have been included in studies to determine the safety and effectiveness of using FluMist among middle-aged and older adults.

I’m not aware of any studies examining how people with trypanophobia feel about the option of receiving an inhaled vaccine. It would be interesting to know whether the availability of FluMist is encouraging these people to get vaccinated against the flu, perhaps for the first time in their lives.

Needles, alas, seem to be ubiquitous in medical care. They’ve been refined into a multitude of sizes and functions. They’re used for everything from basic blood draws to advanced surgical procedures. There’s no denying they sometimes hurt, and you don’t have to have a needle phobia to dislike them or to want to avoid them. Although the use of needles will continue to be inevitable for many medical procedures, it would be a kinder and gentler world if we could use them less often.

West Central Tribune photo by Gary Miller

6 thoughts on “Fearing the needle

  1. I know of several people who get the flumist and then complain of a couple days of runny nose and very slight cold like symptoms. Maybe it’s because the live virus in the flumist triggers it vs the killed virus in the injection? My arm didn’t hurt at all this year but that story about the needle breaking off has freaked me out for the future!!!

  2. In answer to your question, I researched that a little bit but I couldn’t find any definitive information. I would agree with you that the side effects are probably the result of the live virus contained in FluMist. It’s possible the delivery route – into the nose – is a contributing factor, but I didn’t run across any studies or other information that addresses this.

    I hope I didn’t freak out too many people with that story about the needle breaking off. I mean, yikes. But my point is that a lot of people are truly afraid of needles, and often there’s a reason why.

  3. oh, I’m sure the needle breaking is pretty rare. I’ll keep getting my shots. When I was about 10, I was so freaked, I ran out of the dr’s office and locked myself in the restroom. My mom is still embarrassed about my behavior as she re-tells that story. Our children are so brave – they pull up the sleeve and take the shot. Of course I bribe them with the DQ. I’ll skip the flumist. Tried it once and my nose burned for a day and I had a funny feeling throat. Like I said before, the arm wasn’t a problem this year! By the way…I heard they MIGHt bring flumist to the public schools for H1N1 vaccination. Friend was doing hearing and vision screening at school and the nurse told her.

  4. If only trypanophobia were so simple to address. I am a severe trypan: resistive, associative, and hyperalgesic. I am simply unable to tolerate needle procedures (other than dental-don’t know why) without full sedation, such as gas-induced anesthesia prior to administering an IV for surgery. Hypnosis doesn’t work; therapy doesn’t work; cognitive conditioning doesn’t work. I try to negotiate with medical providers on alternatives, but somehow they think if they reject my reasonable accommodations, I will agree. I won’t. I will forgo treatment or diagnostic procedures if they involve a needle unless I am sedated. Fact is, most of the medical profession has no clue that people like me (and there are lots of us) exist since their close-mindedness has resulted in our avoiding even presenting ourselves for medical advice. My hope is that – somehow – those like me can connect and speak with a unified voice in favor of revised protocols that accommodate our condition. Otherwise, most of us are destined to shortened lives due to lack of medical care.

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