Overcoming the Fear of Needles

[Hemodoc]

Overcoming the Fear of Needles
By Peter Laird, MD

The fear of needles, large dialysis needles, is a very commonly cited reason for seeking alternative treatments to hemodialysis with peritoneal dialysis and renal transplantation. I have always  hated needles despite my use of needles on a near daily basis in my internal medicine practice, the difference being I was giving not receiving the use of the needles. Despite my calm assurances to my patients with the needles I used on them, I would run away from my annual TB test which has a tiny little needle injected in the very surface layers of the skin.  While in the Army, I was able to avoid the whole panel of injections needed to be deployed on an emergency basis should they have called. I quite simply hate needles and always have, yet today, not only do I use needles to stay alive, I use very LARGE needles that have an internal lumen large enough to look inside of them.

While all patients starting dialysis express a dislike of needles, there are a small percentage that have an actual physical reaction to needle insertion with heart racing, cold, clammy skin and some people actually pass out.  Scientists have identified up to 10% of the population that have either an acquired reaction to needles and/or a genetic predisposition to the fear of needles.  For patients that must utilize needles for dialysis, this becomes a significant problem not only for the patient, but for the staff treating them.

A common reaction by patients with severe needle phobias is to keep their catheters and avoid fistula or graft placement, yet this exposes them to higher risks of infection and death. Behavioral therapy techniques are effective in overcoming these fears often through forms of desensitization. Home Dialysis Central has an excellent review on the fear of needles and techniques that work at the bedside for patients that all should review if this reaction is preventing you from obtaining the treatment options such as a fistula which is known to improve survival on dialysis: Dialysis Needle Fear: Easing the Sting.

Fortunately, for most patients, it is simply the fear of the pain of the needles themselves that is the issue. Many patients ask for local pain shots before cannulation, but this can cause build up of scar tissue and is best avoided if possible.  A popular form of local anesthesia is topical creams such as EMLA ( Eutetic Mixture of Local Anesthetic) which contains two topical anesthetics, Lidocaine and Prilocaine. Many patients use this product effectively and are able to learn to self cannulate once the pain is controlled. Many patients simply become tolerant to the pain which lasts only momentarily and is accepted as simply a minor inconvenience. 

The most important issue is to not let your fear of needles become a reason for accepting less than optimal renal care. If you are unable to overcome the fear of needles, peritoneal dialysis and renal transplant may help prevent some of the complications associated with long standing catheter use. Ask your nephrologist and nursing staff how to overcome this very common complication of hemodialysis treatment, your fear can be turned away in most cases.

http://www.hemodoc.com/2011/01/overcoming-the-fear-of-needles.html

[Hazmat35]

Ever since I was a small child, I have had a fear of needles, since Way back when you had to stay several days to have your tonsils taken out.  I had a (male) nurse tell me to stop crying or he was going to give me a shot with a large needle, and then I'd have something to cry about.  He shoved a syringe in my face to make sure I got the point. 

Since then, for over forty years, just the thought of having to get a shot or blood work, set me over the top.  I would panic, and sweat and have heart palpitations, just THINKING of it.  When it came time to do it, i usually passed out! 

Having any type of surgery or work in the hospital with an IV was out of the question.  NOT HAPPENING!  I'd rather have died. 

But, the past year, I have over come my fear, just by FACING IT and learning to overcome.  Now I can sit up in the "BIG BOY" chair as my wife calls it when I have to have blood work done, and not lay on the couch.  But, when it comes to Dialysis, I still "PANIC".  I do my deep breathing exercises, I talk to other nurses, and don't watch!  I'm getting better, but I still have severe anxiety over it. 

[Hemodoc]

Ever since I was a small child, I have had a fear of needles, since Way back when you had to stay several days to have your tonsils taken out.  I had a (male) nurse tell me to stop crying or he was going to give me a shot with a large needle, and then I'd have something to cry about.  He shoved a syringe in my face to make sure I got the point. 

Since then, for over forty years, just the thought of having to get a shot or blood work, set me over the top.  I would panic, and sweat and have heart palpitations, just THINKING of it.  When it came time to do it, i usually passed out! 

Having any type of surgery or work in the hospital with an IV was out of the question.  NOT HAPPENING!  I'd rather have died. 

But, the past year, I have over come my fear, just by FACING IT and learning to overcome.  Now I can sit up in the "BIG BOY" chair as my wife calls it when I have to have blood work done, and not lay on the couch.  But, when it comes to Dialysis, I still "PANIC".  I do my deep breathing exercises, I talk to other nurses, and don't watch!  I'm getting better, but I still have severe anxiety over it.

Dear Hazmat35, you are one of the "luck" 10% with severe fears of needles.  I have always hated them, but I don't get the physical reaction you are describing.  I suspect the more you face this fear, hopefully over time you will become desensitized to the reaction.  It is a condition that behavioral therapies can help with as well including the relaxation techniques you describe.  I guess the biggest issue is realizing how common this reaction is.  Perhaps one day you this will just be an old memory.

I wish you the best.

God bless,

Peter

[KICKSTART]

Im sorry but i find this a very blinkered view with several 'black & white' quotes like :        The most important issue is to not let your fear of needles become a reason for accepting less than optimal renal care. If you are unable to overcome the fear of needles, peritoneal dialysis and renal transplant may help prevent some of the complications associated with long standing catheter use.

But then i see this guy is ex army , which would probably explain his view on this, meaning, they accept orders without question and face many situations that none of are likely to come across in day to day life.

[Hemodoc]

Im sorry but i find this a very blinkered view with several 'black & white' quotes like :        The most important issue is to not let your fear of needles become a reason for accepting less than optimal renal care. If you are unable to overcome the fear of needles, peritoneal dialysis and renal transplant may help prevent some of the complications associated with long standing catheter use.

But then i see this guy is ex army , which would probably explain his view on this, meaning, they accept orders without question and face many situations that none of are likely to come across in day to day life.

Sorry, but I am the person who is ex Army and we DID not accept orders without question as physicians in the Army. My name is Peter, you don't have to call me this guy.  My goodness!

People that do not overcome their fear of needles and thus do not get fistula placement are at a higher risk of death and other complications.  Sorry, but that is a black and white statement of facts. If you have studies that show different, please share it with us please.

[needlephobic]

Im sorry but i find this a very blinkered view with several 'black & white' quotes like :        The most important issue is to not let your fear of needles become a reason for accepting less than optimal renal care. If you are unable to overcome the fear of needles, peritoneal dialysis and renal transplant may help prevent some of the complications associated with long standing catheter use.

But then i see this guy is ex army , which would probably explain his view on this, meaning, they accept orders without question and face many situations that none of are likely to come across in day to day life.

Sorry, but I am the person who is ex Army and we DID not accept orders without question as physicians in the Army. My name is Peter, you don't have to call me this guy.  My goodness!

People that do not overcome their fear of needles and thus do not get fistula placement are at a higher risk of death and other complications.  Sorry, but that is a black and white statement of facts. If you have studies that show different, please share it with us please.I have always been afraid of needles.

When a was a young kid around 8 or 9 was in hospital recovering from hernea surgery was in pain nurse was wanting to give me a shot I refused to turn over and she stabbed me in the leg with it like a person with a knife. That was back then when they would stick you any way possable or would restrain you that is far as I remember cause I was scared then so something else happened that I don't remember. People who don't have needle phobia don't understand it. I tried desensitization with my social worker and she said it made me worse> I was in her office she had the D needle arm leangh away from me and I still freaked out I was in a fetal postion in the chair begging her to get rid of it.

[Chris]

Being diabetic as a kid, I was at first fearing them. At that time, big needles were used for some immunizations too, but not are as small as the insulin syringe. As I grew older and stopped giving them in my stomach, I had that fear of giving them there, but not in my arms, legs, or buttocks. Then came the insulin pump which had a lancing device that made it easier to do, but with fear still lingering since at times one had to manually insert it especialy depending on the needle used at that time. Dialysis came along and ohhh crap those needle were huge and lidocain, freezing spray, and the cream did not help (kinda made it worse to). The thing I noticed is that it just took time for that fear to diminish, but now it just depends were that needle is going such as an IV that is not going in a usual place I am use to, but also the feeling of the IV feeling its way aound to find the sweet spot to doesn't help. Regual bi weekly labs I am use to even though I am starting to feel a slight pain when the needle is pulled out due to all the scar tissue, but one thing I still can not do is do a blood draw or start an IV myself due to fear even though I know what to do and where to go (some nurses just don't listen and get upset because they couldn't get it right).

[KICKSTART]

Whoa there PETER ! Im sorry for not being able to remember every members real name ! I thought you had posted this as a quote rather than your own view.
Again i put to you, all you are saying in a long winded way is ...dont like needles ? suck it up !
Ask Needlephobic about fear of needles and the lengths he is going to , to try and overcome this, but cant ! .
Again you have repeated the statement : People that do not overcome their fear of needles and thus do not get fistula placement are at a higher risk of death and other complications.  Sorry, but that is a black and white statement of facts.

We have a high risk of dying from a lot of things dont we? People with pd cath's have a high risk of infection , yes peritonitis can kill but we dont discourage that do we ?

[needlephobic]

I really don't know how to explain the fear of needles. There is a difference in hating  needles and being afraid of needles. People hate taking shots people like me that are afraid of needles avoid anything that has to do with needles at all cost. I have trust issues with the nurses or techs or whoever is going to stick me with a needles. I tried desensitization social worker said it made my fear worse. Tried xanax froze in fear twice couldn't run just collapsed in fear.hypnoses doesn't work on everyone told to me by a doc that does it and he believes it wouldn't work on me.Thought about hypotheraphy can't find anybody around here that has experience with needle phobia to work with me on it. You tell needle phobics to suck it up and do it. So do you tell a depressed person oh just cheer up don't work that way. I have been fighting this all my life. I am shaking right now typing this.Been told alot of times try the cream or the spray to deaden the pain of being stuck. The pain of it is part of the problem but the fear is the huge problem. Some people faint i am one of the people that will fight tooth and nail to keep from being stuck the guy you have to hold down or tie him down or just knock him out. To live like this is hell for me something in my past screwed me up. It is not my fault I want to knock somebody on there butt if they try to stick me so don't say if you hit me I will press charges cause I can't help it. I just want help but people don't understand unless they are in my shoes       
   

[Hemodoc]

I really don't know how to explain the fear of needles. There is a difference in hating  needles and being afraid of needles. People hate taking shots people like me that are afraid of needles avoid anything that has to do with needles at all cost. I have trust issues with the nurses or techs or whoever is going to stick me with a needles. I tried desensitization social worker said it made my fear worse. Tried xanax froze in fear twice couldn't run just collapsed in fear.hypnoses doesn't work on everyone told to me by a doc that does it and he believes it wouldn't work on me.Thought about hypotheraphy can't find anybody around here that has experience with needle phobia to work with me on it. You tell needle phobics to suck it up and do it. So do you tell a depressed person oh just cheer up don't work that way. I have been fighting this all my life. I am shaking right now typing this.Been told alot of times try the cream or the spray to deaden the pain of being stuck. The pain of it is part of the problem but the fear is the huge problem. Some people faint i am one of the people that will fight tooth and nail to keep from being stuck the guy you have to hold down or tie him down or just knock him out. To live like this is hell for me something in my past screwed me up. It is not my fault I want to knock somebody on there butt if they try to stick me so don't say if you hit me I will press charges cause I can't help it. I just want help but people don't understand unless they are in my shoes       
 

Dear Needlephobic, I apologize for any untoward thoughts of telling people just to suck it up which you did not hear at all from me. That is not my message nor is it the message of the health care industry.  I deliberately placed a link to Home Dialysis Central on the issue of needle phobia to give further information for the 10% of patients who suffer from this condition offering effective treatment options, this is not at all stating just suck it up when I have given links to information on how many people overcome this issue.  I cannot do anything about people who wish to stir up trouble that does not exist.  I can however correct words attributed to me that I have not stated nor do I agree with.

Needlephobia is a real reaction with physiologic effects as I noted in my short post on this issue.  It is difficult to treat in some but not all patients.  For those who cannot overcome the fear of needles, considering alternative treatment options is one survival strategy to consider that is recommended by those that deal with this issue in their practice and are not able to get the patient over their signifcant fears. No one is belittling the issue, only trying to offer people information on how they can overcome or avoid the issue if not able to overcome it.

In all issues, seeking out specialists with experience in this field is helpful. Recognizing the risks of our own decisions is paramount to obtaining the best care possible, but in the final analysis, people are allowed rightfully so to make their own decisions.

I wish you the best in this difficult situation and again I apologize for people who have attributed words to me that I have not spoken, nor do I agree with.

God bless,

Peter

[KICKSTART]

This is referring to me i take it ?
Quote;I cannot do anything about people who wish to stir up trouble that does not exist.  I can however correct words attributed to me that I have not stated nor do I agree with.

FIRSTLY i did not say that you made this statement , if you would care to re-read my post you will see i said :what you have written is a long winded way of saying if you dont like needles ..suck it up.: So dont apologise on my behalf , if any needs an apology i am quite capable of doing it myself !  Secondly , i dont like the innuendo that i am a trouble maker , oh sorry that would be :people who wish to stir up trouble that doesnt exist.: If voicing my opinion on what you have written is stirring up trouble then we had all better stop posting !
Despite your ideals i am still interested to know your views on people who cannot overcome this fear and have NO other option but Hemo . Also you have made no comment to the fact that PD involves the placement of a catheter , which also carries a high risk of infection , should people not choose to do pd so as to lessen the risk ?
Finally excuse me for saying so but MD or not , i do find you have the attitude of one .

[KICKSTART]

Needlephobic ...check your in box 

[monrein]

I read Peter's post 5 times, each and every word,  and I found it to be articulate, empathic towards those of us who dislike needles, those of us who fear the pain of them, those of us who "hate" them and those of us who are truly needle phobic in the medical sense of phobic.  I found the distinctions useful and I've personally talked with patients who fall into most of the different categories.  I also think it is helpful for patients to know that there exist techniques to try to overcome the various levels of anxiety around cannulation and needles and we all have to surmount both the physical and the psychological aspects of the hemodialysis experience if that is the modality we choose or must learn to accept as the case may be.
Nowhere did I read an explicit  or an implicit message that a patient should just "suck it up".  On the contrary I found the post contained a variety of suggestions to lessen pain or fear, to TRY to deal with real phobia etc and all because some of the practices around hemodialysis (lidocaine shots, permacaths for too long, etc and  I would add improper laddering or buttonhole techniques) are not in our long term interests. 

I threw up the first time I was cannulated by a nurse, but determined that I would do my own needles in order to avoid aneurysms and prolong the life of my precious fistula.  I refused lidocaine for the same reasons (also made the vein shrink away and thus harder to hit) and way back in 1980 no one offered me emla cream.  I developed my own techniques of self-distraction, self-talk and preparation for needling.  I used to practice pinching myself very very hard which hurt worse than the needles and I used meditative techniques and breathing to calm myself.  I did all my own needles for 5 years until transplanted and after that kidney failed I self-cannulated doing the buttonhole technique with blunts, again to preserve my fistula by ensuring consistency.  My understanding is that these are good practices in the long run and I tried hard to suck up whatever I had to in order to be as successful as possible with my dialysis. 
This doesn't mean that everyone can do this, I personally know many who cannot but I also know that in my unit there were a few patients who sought me out to talk about ways to overcome their fears, hesitations, anxieties etc and several were also successful...to their great surprise I will add.

I still wish we didn't need to be stuck or to stick ourselves.

[carson]

I am needle phobic! I've been on PD, didn't work. I'm not a candidate for transplant. I have a catheter on Nocturnal Home Hemo and I keep trying to get over the needle thing but I CAN"T. The medical team brings up the word FISTULA and I want to jump out the window.  It's not fun. It's not logical. BUT I CAN'T HELP IT!!!







EDITED: Fixed smiley tag error-kitkatz,Moderator

[tyefly]

I have to agree with Monrein....   I think Peter's Post was filled with usefull information..... 

I have a fear of spiders.... big time...yet  there are those people who just laugh at my fear.....   I think there are many people who have a fear of needles....it took me a few months just to look at when they cannulated me....ill   

We need to face fear....  not run from it...there are ways to get around the fears.....   I will always have fear of spiders....but I do garden .....  I just use tools....when I pick my strawberries... I use thongs to pick them.... I would never put my hands in the bushes.... Daddy long legs have moved and given me the chills....but I still love plants and gardening ....we just figure out how to get past or how to do thing different to overcome it....its hard....   but its possible......   Never say Never

[murf]

I can't help but sympathize. Two possible solutions. I use emla cream that numbs the skin bot don't take the cling wrap off until the very last minute and that way the effect is maximized. Tell the nurse to use old punctured areas. It toughens the skin up. Once had a nurse who loved 'exploring' my arm so every time it hurt like hell.

[monrein]

I can't help but sympathize. Two possible solutions. I use emla cream that numbs the skin bot don't take the cling wrap off until the very last minute and that way the effect is maximized. Tell the nurse to use old punctured areas. It toughens the skin up. Once had a nurse who loved 'exploring' my arm so every time it hurt like hell.

I know what you mean about there being less pain where there is more scar tissue built up from repeated stickings BUT it's important to also be very aware that this repeated use of familiar spots is what can lead to aneurysms (those horrid big bulges) over time.  Best technique ,if using sharps, is to ladder up and down the fistula in as consistent manner as possible.  Start at the bottom and each time go up a tiny bit so your fistula will develop as evenly as it can.

[Hazmat35]

EXCELLENT TIP!!!!

[needlephobic]

Here is a example of my fear of needles. do to being afraid of needles I got 2 groin herneas a detached bladder that need to be fix. I am to afraid of needles to get all that fixed. I have avoided needles all my life. I know I need to get all that fixed but them needles stand in my way.Just can't do it. As of this Feb 6th I will have this chest cath in a whole year. How was I able to get the cath in which requires needles for IV? At that time I was very sick couldn't fight Doc wanted it in for D as soon as possable. I have a fistula was told it is the best ever seen and ready to use. But them needles just can't do it I freak out when I see them. Yes got the fistula when I got the chest cath put in. Thought I could do the needles nope got freaked out. Still looking for help but no therapist here has dealed with a person with needle phobia.     

[Katonsdad]

I hated getting the needle whne I was on Hemo /  They would give me the Chicken Juice (lidocaine) as a shot with
smaller needles .   Finally I got into the mindset that as they put the needle in , it was already in so I was past it.
By the time the needle was going in my mind thought it was in and done so it did not bother me.

[murf]

I'm not sure if this is medically correct but what about a mild tranquilizer like Valium or paxam. Once again I feel for you and could not think of anything worse.