Fear of needles could be a barrier to COVID-19 vaccination, but here are ways to overcome it
As progress continues in the search for a vaccine that prevents COVID-19, millions of Americans are afraid even of getting the vaccine: Studies suggest 63% of young adults – those born in 2000 or later – fear needles.
Like a doctor trained in pediatrics, I think we have found the answer to the huge increase in needle phobia. Now – and even more critical: what could ease the pain and fear of needles?
A landmark 1995 study on needle phobia reported that 10% of adults and 25% of children were afraid of needles. The study also noted what typically caused their fear: a “needle stick event” around age five.
In 2010, our team conducted a study on vaccine pain in preadolescents. Of the 120 children screened, 114 reported suffering from needle anxiety. It really surprised us. As in the previous study, we thought maybe 25% would be afraid; instead, it was 95%. (By the way, some parents were annoyed – many called their children to be “wimps.”)
Why there is more phobia of needles
We wanted to understand what was creating this new anxiety. So we looked at the group’s vaccination records since birth. Maybe then we could find role models that caused this surge in fear.
It turned out to be the needles.
Over the past 40 years, we have added 30 injections in the immunization schedule of a child. That’s a good thing: today in the United States, children almost never die from an infectious childhood disease. But the fear of the needle has blossomed.
The number of childhood vaccines was correct. But we found that half of the children who received all of their preschool boosters in one day – that is, four or five injections at a time – were in the highest fear quartile five years later. Note: Over the next three years, this group was two and a half times less likely to receive the HPV vaccine.
But none of the children who received only one injection at each visit during the full four to six years were scared. Maybe they’ve grown resilient, able to cope with a quick hit. Maybe five injections per visit is too much, especially when you are old enough to remember.
Experts in the field – like Dr Anna Taddio from the University of Toronto – realized that fear of needles could affect vaccination rates. She and other Canadian scientists created Guidelines for reducing pain associated with vaccination. Published in 2015, these guidelines suggested that interventions, occurring during vaccine preparation and reception, would be useful.
Interventions can mean distractions. For young children, fear can be reduced by letting them blow on a toy reel. For an older child, this might be while watching videos or listening to music. For pain, topical anesthetics help numb the skin. The same goes for numbing muscles with “Buzzy,” the vibrating cold device we tested in tweens. Pain is reduced when placed over the shot area for one minute, then moved close to the area while the injection is taking place. Of them meta-analyzes showed Buzzy provided significant relief from pain and fear – a decrease of 40 to 74% for children, and a better experience for adults when they receive a vaccine against influenza.
In addition to Buzzy: Cold spray, topical anesthetics and Shotblocker – a horseshoe-shaped device placed near the shot zone – have been studied for injections in adults. Compared to no intervention, they helped reduce pain.
New guidelines could be released later this year. This too will be useful; our knowledge of vaccine pain has increased dramatically over the past five years. Many of the 2015 recommendations were speculative and extrapolated from studies of intravenous insertions, which do not directly correlate with pain interventions for injections. In addition, many studies evaluating the distractions caused by blowing bubbles or wearing virtual reality glasses come from laboratory prints. Reliable data on vaccinations are relatively scarce.
Use multiple distractions, enter with a plan
Yet all of the suggested interventions have one thing in common. They address the pain, fear and frightening memories of past events in
change patient orientation during a procedure.
A Systematic review for pain vaccine concluded that interventions should have cold and vibration, as well as some distraction – for example, using Buzzy while the patient is watching a video or listening to music. The patient must choose the activity and then remain engaged while the shot is prepared and administered.
If you are faced with an injection – a vaccination, lab sample, or blood donation – the best strategy is to have a plan in advance. Discuss the procedure with the clinician; bring a friend with you. Have a game you can play while everything is going on – this way the brain is too busy to be afraid and the perception of pain decreases. Any smartphone app that involves touch and skills is a great place to start. Maybe it’s time to play Pokemon Go again.
Physical intervention during the procedure – pointing, touching, coughing – can help. Or combine rote performance with visual identification. During the poke, look at something on the wall with writing on it; focus on one sentence and count the number of letters with holes (eg there are two in “holes”). This engages the part of the brain responsible for the risk analysis.
Needle phobia is a direct threat to public health. Those who are afraid of hits may not get them. With COVID-19 upon us, battling the fear of needles becomes more than making the doctor visit more enjoyable. Now it really is a rescue effort.
Editor’s Note: An updated version of this article was posted on June 11, 2021. Read it here.
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