P.A.C.E.® Approved COURSE DESCRIPTION - National Center for ...

*Valid for P.A.C.E. ® credit through 12/31/2015*
COURSE DESCRIPTION
Can you imagine being so afraid to have your blood drawn or to
get an injection that you avoid any sort of medical care?
Approximately 3.5% - 10% of the general population suffers from
fear of needles or needle phobia. The medical term for needle
phobia is belonephobia. Belonephobia is a recognized disease in
the Diagnostic and Statistical Manual of Mental Disorders (DSM-
IV) as Specific Phobia (SP), Blood-Injection-Injury Type. The
2010 ICD-9-CM Diagnosis code is 300.29, Other Isolated or
Specific Phobias. It is important that healthcare professionals
know how to recognize and manage this disorder.
Rev 2.0
©3/2011
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COURSE TITLE: Needle Phobia
Author: Lucia Johnson, M.A. Ed, MT(ASCP)SBB
Vice President, Recertification
National Center for Competency Testing
Overland Park, KS
Number of Clock Hours Credit: 1.0
Course # 1222614
P.A.C.E. ® Approved: X Yes No
OBJECTIVES
Upon completion of this continuing education course, the professional
should be able to:
1. Identify the medical term for needle phobia.
2. List reactions seen in phobics when they are faced with the object or
situation of their fear.
3. Identify three main categories of phobias.
4. Describe the impact of needle phobia on individuals and the
healthcare community.
5. Describe four broad types of needle phobia.
6. Identify how needle phobia is diagnosed.
7. List symptoms seen when a needle phobic patient encounters a
needle.
8. Discuss how needle phobia affects the patient’s daily life.
9. Identify two main causes of needle phobia.
10. Describe the management of patients with needle phobia.
11. Identify recommendations to prevent the formation of needle phobia.
Disclaimer
The writers for NCCT continuing education courses attempt to provide factual
information based on literature review and current professional practice. However,
NCCT does not guarantee that the information contained in the continuing education
courses is free from all errors and omissions.
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INTRODUCTION
Can you imagine being so afraid to have your blood drawn or get an injection that you
avoid any sort of medical care? Approximately 3.5% - 10% of the general population
suffers from fear of needles or needle phobia. The medical term for needle phobia is
belonephobia (pronounced bell-o-ne-phobia). Belonephobia is a recognized disease in
the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as Specific Phobia
(SP), Blood-Injection-Injury Type. The 2010 ICD-9-CM Diagnosis code is 300.29, Other
Isolated or Specific Phobias. It is important that healthcare professionals know how to
recognize and manage this disorder.
WHAT IS A PHOBIA?
A phobia is a type of anxiety disorder. It is an overwhelming and unreasonable fear of a
situation or object that really poses no danger. Examples of phobias include fear of
snakes, heights, public speaking, flying, and enclosed spaces. Some individuals have
anxiety reactions just thinking about what they fear.
When faced with the object or situation, phobic individuals are likely to have some or all
of the following reactions:
a feeling of uncontrollable anxiety,
a feeling that they must do everything possible to avoid what they fear,
an inability to function normally because of their anxiety,
the ability to know that their fears are unreasonable but they feel powerless to
control them, and
physical and psychological reactions such as sweating, difficulty breathing, rapid
heartbeat, and fainting.
An individual may experience phobic reactions just when thinking about what he/she
fears.
Phobias are divided into three main categories: specific phobias, social phobia, and
agoraphobia.
Specific phobias are those that relate to a specific thing such as fear of heights,
snakes, storms, etc.
Social phobia is a combination of extreme self-consciousness, fear that others
judge the individual negatively, fear of humiliation in social situations, and fear of
public scrutiny.
Agoraphobia is a fear of open spaces. Individuals with agoraphobia have a fear
of stores, malls, doctor offices, outdoors, etc., and they only feel comfortable in
their own homes. Some agoraphobics never leave their homes.
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Many individuals have unreasonable fears, and these fears are not considered phobias
until they begin to disrupt their daily lives. At this time, individuals should seek medical
or psychological treatment. Many individuals with phobias can be helped with the
correct therapy. Therapies may include behavioral therapy and use of medications
such as sedatives, antidepressants, and anti-anxiety drugs.
The cause of phobias is still unknown. Many studies show a strong genetic correlation
in that the same phobias are seen in many family members. Other studies show that
traumatic experiences and brain chemicals influence the development of phobias.
Children may also learn phobias by observing a family member’s phobic reaction to an
object or situation.
NEEDLE PHOBIA
General Information
Needle phobia is a fear of needles. This condition is called belonephobia and is
sometimes spelled belophobia. Related phobias include aichmophobia (fear of pointed
objects), algophobia (fear of pain), and trypanophobia (fear of injections). Individuals
with needle phobia fear injections, blood collection, blood donation, IV insertion, dental
injections, TB skin tests, skin punctures, and any other type of treatment that requires a
needlestick. Some individuals with needle phobia are so terrified of needles that they
would rather die than have a needle procedure.
Dr. James D. Hamilton, MD, has written the only comprehensive review of needle
phobia in medical literature, Needle Phobia: A Neglected Diagnosis. His article was
published in the August 1995 issue of The Journal of Family Practice. [Vol.41, No.2, pp.
169-175]. Dr. Hamilton identified a need to review and publish a paper on needle phobia
as he observed individuals who avoided medical treatment, which can lead to serious
health problems as well as social and legal problems.
Laboratory blood tests are one of the most important diagnostic tools used in medicine
today. It is estimated that there are more than 900,000 blood draws and injections
performed daily in U.S. physician offices and diagnostic laboratories. Vyteris Holdings,
Inc, a leading developer of drug delivery products, conducted a survey in the fall of 2006
that identified more than 15 million American adults and 5 million American children
over the age of 5 who suffer from high discomfort or exhibit needle phobic behavior
when faced with a needle procedure. Dr. Mark Durstzman, MD, Clinical Assistant
Professor of Medicine, Weill Medical College of Cornell University, and Assistant
Attending Physician, The New York Presbyterian Hospital, Cornell Campus, states
“Needle phobia has a direct impact on my ability to deliver necessary healthcare
services, and is an important public health issue. The findings [of the Vyteris survey]
brackets usually used for editorial insertions underscore how widespread the issue is,
and directly correlate to my personal experience as a physician dealing with patients.
Needle phobia can be a significant impediment to understanding a patient’s complete
health profile. The healthcare community needs to advance more solutions to deal with
needlestick pain.”
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Types of Needle Phobia
There are four broad types of needle phobia. Some individuals may not clearly fit into
one type.
1. Vasovagal Reflex Reaction: Individuals with this type of needle phobia
experience a vasovagal reaction when faced with a needle. Their symptoms are
bradycardia (slow heartbeat) and hypotension (low blood pressure) with pallor,
diaphoresis (sweating), tinnitus (ringing in the ears), and syncope (fainting) or
near syncope, and sometimes asystole (cardiac arrest), or death.
The vasovagal reaction generally occurs only after puberty and is more common
in men than in women. This is the most common form of needle phobia.
When needle phobia results in syncope, it may be accompanied by convulsions
and respiratory or cardiac distress. There have been at least 23 documented
cases of death resulting from needle phobia.
2. Fear of the Unknown: This is common in young children. They are afraid of
needles as they experience needlesticks infrequently. Most children outgrow
this fear. However, others may become adult needle phobics, especially if the
needle procedure is traumatic and not handled well.
3. Acute Sensitivity to Pain: Some individuals have an acute sensitivity to pain. A
procedure that is essentially painless to one individual may cause intense pain in
another. Needlesticks for these individuals are unbearable.
4. Classic Needle Phobia: This is the rarest type of needle phobia. Individuals with
this type of needle phobia had a traumatic experience with needle procedures at
a young age and this lead to the development of a phobia.
Diagnosis and Symptoms of Needle Phobia
A dislike or mild fear of a needle procedure is very common. This type of fear is not
needle phobia. Needle phobia is demonstrated by the following clinical findings and
symptoms.
Past Medical History
o The patient tells the healthcare practitioner that he/she has had a longterm
unreasonable fear of needles since childhood.
o The anticipation of or exposure to a needle triggers immediate anxiety and
may turn into a panic attack. Panic attacks in adults include heart
palpitations, nausea, shortness of breath, chest pain, pale skin, sweating,
trembling, and sense of dread. Panic attacks in children are manifested
by crying, physical agitation, and clinging to parents or caregivers.
o The patient avoids needle procedures and associated situations all or
some of the time.
o The fear and avoidance of needles significantly interferes with healthcare
and other activities or the patient is very distressed about having the fear.
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Family Medical History: About 80% of needle phobic patients say that a firstdegree
relative (parent, child, or sibling) also has needle phobia.
Clinical Findings
o When exposed to a needle, the patient experiences syncope, near
syncope, light-headedness, and/or vertigo along with pallor, nausea, and
sweating.
o Blood pressure or pulse, or both, drop.
o Electrocardiogram shows abnormalities or irregularities of almost any
type.
o There is a rise in stress hormones such as antidiuretic hormone,
dopamine, human growth hormone, catecholamines, corticosteroids,
renin, and beta-endorphin.
Examples of Needle Phobic Individuals
A review of the literature reveals the following examples of self-reported or diagnosed
needle phobic individuals.
1. Patient A, an expectant mother, was permitted by the court to risk the life of her
unborn child by refusing a C-section due to needle phobia. The mother did not
receive IV fluids or pain medication. The delivery was difficult and the baby
suffered serious, but not life-threatening, complications.
2. Patient B loved to travel. He restricted his travel destinations to countries that did
not require vaccinations, as he was terrified of injections. He really would like to
visit South America and Asia but vaccinations are required and he will not
receive them.
3. Patient C is an adult diagnosed with type 1 diabetes that requires twice-daily
injections of insulin. She is not able to manage her disease, as she is terrified of
giving herself the insulin injections. Due to needle phobia, she has serious
health issues that may become life threatening.
4. Patient D has experienced significant pain and developed serious periodontal
disease, resulting in the loss of teeth due to the fear of dental injections.
5. Patient E is a husband and father of two young children. He will not take out a
life insurance policy due to the requirement of blood testing. He is a needle
phobic and will not have his blood collected for the required testing.
6. Patient F is a young woman in the military. She would like to become a pilot but
the school requires blood testing prior to entry and, if she were to become a pilot,
she would be required to have annual blood tests. She is working with a
psychologist to overcome her needle phobia so she can advance her position.
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7. Patient G is a woman who really wants a child. She is approaching 40 and is
trying to gather courage to visit an obstetrician. She fears pregnancy due to the
need for periodic lab work and IVs during labor and delivery.
8. Patient H is a man in his 60s who injured his knee and needs laparoscopic
surgery to repair the damage. He is so terrified of needles that he declines
surgery and would rather suffer the severe pain of his injury.
Causes of Needle Phobia
As with other phobias, the exact cause of needle phobia is unknown. However, studies
show that needle phobia may be both an inherited and learned trait.
About 80% of needle phobics have a parent, child, or sibling (a first-degree relative) with
needle phobia. The presence of a genetic trait in needle phobia probably evolved in the
human species in response to cutting, piercing, and stabbing injuries from animal teeth,
claws, fangs, and tusks. This trait continued to evolve to fear of injuries from sticks,
stone axes, knives, arrows, spears, and swords. The reflex that promoted the learning
of a strong fear of skin puncture taught humans to avoid such injuries. This resulted in
the creation of the vasovagal reaction reflex. Over the years, most individuals have
learned to cope with a fear of needles and they are able to undergo needle procedures
with few problems. Other individuals still maintain a strong fear of needles. As with
other human traits, some individuals express the needle fear in a strong manner while
others have only a weak fear.
A learned component of needle fear has also been identified. An individual who has
had a traumatic experience with a needle procedure as a child may develop negative
conditioning and become fearful when undergoing future needle procedures. Studies
have also shown that children or siblings learn to react negatively to needle procedures
after having seen a parent or sibling have a traumatic experience. The average age of
onset for learned fear of needles is eight years.
Management of Patients with Needle Phobia
Following are methods of managing patients with needle phobia. Not all methods work
with all patients. Healthcare providers and needle phobic patients must be patient as
they work through different types of management until one is found that works.
Communication and Education
Healthcare personnel should be knowledgeable about how to handle needle phobia so
they can appropriately treat these patients. In turn, patients should freely tell healthcare
personnel about their phobia so their treatment can be appropriate. It may be
necessary for patients to initiate the conversation and educate healthcare professionals
about needle phobia. Once educated, then healthcare professionals need to be a
champion for needle phobic patients and assist them in any way possible.
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Most needle phobic patients have been told that they are “wimps” or “babies” and that
they just need to “grow up and cooperate”. They may be embarrassed about their
condition. Therefore, healthcare workers should treat these patients with empathy and
respect. A discussion of the prevalence of needle fear, the inherited nature of it, and
methods available to manage it may reassure the patient.
Positioning
Many needle phobics experience a vasovagal reflex reaction (fainting). To prevent this,
patients should lie down with their legs elevated and their heads lowered. This helps
prevent fainting and the symptoms that accompany it. As some needle phobic patients
do not faint until after the procedure, they should be encouraged to remain lying down
or sitting until they feel comfortable slowly standing up.
Topical Anesthetics
Information about minimizing procedure pain is growing, as there is increased interest
and awareness among healthcare workers. Due to this, the use of topical anesthetics
prior to IV insertion, injection, and venipuncture is increasing. Topical anesthetics have
two disadvantages: many take a long time to become effective and many only numb the
very top of the skin, allowing deeper needlesticks to be felt.
Before initiating the use of any topical anesthetic, the literature should be researched
and the manufacturer’s instructions reviewed and followed. Information on topical
anesthetics follows.
L.M.X.4®
L.M.X.4® is a non-prescription topical cream containing 4% lidocaine.
The 4% strength of lidocaine causes a loss of feeling in the skin and surrounding
tissues. As numbing occurs, a slight cooling sensation may occur.
L.M.X.4® is applied at least 30-45 minutes before the start of the procedure.
The manufacturer provides a clear plastic film to cover the cream after
application to prevent accidental ingestion or removal of the cream.
EMLA® (Eutectic Mixture of Local Anesthetics) Cream/Transdermal Patch
EMLA® is a prescription cream/transdermal patch containing 2.5% lidocaine and
2.5% prilocaine.
The cream must be covered with a clear plastic film after applied to the skin. The
transdermal patch is simply applied to the skin.
EMLA® takes at least 60 minutes to provide numbing sufficient for needle
insertion.
Pain Ease® Instant Topical Anesthetic
Pain Ease® is a skin refrigerant that provides immediate temporary numbing that
lasts up to one minute. It is applied by spraying and it can be reapplied as
needed.
Pain Ease® contains pentafluoropropane and tetrafluoroethane.
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Gebauer’s Fluoro-Ethyl® Topical Anesthetic Skin Refrigerant
This spray skin refrigerant is very similar to Pain Ease®. It provides immediate
temporary numbing that lasts from a few seconds to a minute.
Gebauer’s Fluoro-Ethyl® contains ethyl chloride and dichlorotetrafluoroethane.
Zingo®
Zingo® was approved by the FDA on August 17, 2007, for venous access
procedures (IV insertions and venipuncture) in children aged 3-18 years.
Zingo® is a sterile lidocaine powder that is applied topically, and begins working
in one to three minutes.
Ametop® Gel
The active ingredient in Ametop® Gel is tetracaine.
The gel is applied and covered with a dressing for 30-45 minutes.
Ametop® Gel is used in Canada, England, and Europe but it is not approved by
the FDA for use in the United States.
Iontophoretic Topical Anesthesia
Iontophoretic topical anesthesia is a non-invasive, needle-free method to deliver dermal
anesthesia. It provides anesthesia deep into the tissues in approximately 10 minutes.
A topical anesthetic of lidocaine is applied to the skin in the form of a patch. The patch
is then attached to a small, battery-powered unit that drives the medications into the
tissue. This procedure is painless. Two examples of iontophoresis are Numby Stuff®
(Iomed, Inc) and LidoSite® (Vyteris, Inc). Another system, SonoPrep® (Sontra Medical
Corp) uses ultrasound energy to deliver topical anesthetics into the skin.
Reports from many needle phobic patients indicate that this is an excellent method to
prevent the pain from needle procedures.
Alternative Methods of Medication Delivery
Advances in medication delivery have allowed for the development of nasal sprays,
adhesive patches, inhalation, high-pressure air jet injection, oral, and sublingual
methods as alternatives to injections using needles. Nasal sprays are available that
deliver vasopressin, calcitonin, insulin, and influenza vaccines. New methods of
delivering insulin include nasal sprays and high-pressure air jets that force the drug into
the skin. SonoPrep® (mentioned above) is being investigated as a method to deliver
insulin and low molecular weight heparin such a Lovenox®. Patients with severe pain
may be treated with topical analgesic patches, oral and sublingual narcotics for pain
control, and opiate suppositories.
Researchers at Georgia Institute of Technology have developed several prototypes of
microneedle devices. These devices have up to 400 tiny needles made of silicon,
metal, or polymer, each of them 1 to 1,000 microns in size. The microneedles can be
solid and coated with a drug, or hollow and filled with a drug. Studies have shown that
test subjects could not tell the difference between a smooth, flat surface pressed
against the skin and the microneedle used to inject drugs into the skin.
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Mark Praunitz, one of the researchers involved in the development of microneedles,
believes these could possibly eliminate the need for hypodermic needles for injections.
Applied Muscle Tension
A leg crossing or lifting technique called applied muscle tension can prevent or delay
the vasovagal reflex reaction. This technique temporarily increases blood pressure,
thus preventing fainting. Studies have shown that this technique is effective for some
needle phobics. It has also been useful to prevent vasovagal reactions in blood donor
facilities. The technique begins with the patient/blood donor lying down. One leg is
lifted or crossed every 5-10 seconds. The leg is brought up at least 12 inches above
the bed, and then immediately crossed over the other leg or brought back to rest on the
bed. This action is repeated with the other leg.
If a needle phobic patient is unable to lie down for a venipuncture or injection, the same
effect can be obtained by having the patient sit with his/her legs crossed. Every 5-10
seconds the patient should press the lower legs together a few seconds at a time while
breathing normally.
Anti-Anxiety/Sedative Drugs
Fast-acting anti-anxiety drugs such as diazepam (Valium®) can be administered prior to
the needle procedure to sedate the patient. A relatively large dose may be needed and
sedation may not take effect until 15 minutes from ingestion of the drug. Nitrous oxide
(inhaled) and Xanax® may also work. Sedative drugs such as barbiturates, Halcion,
and others may also work. Anti-anxiety and sedative drugs work to prevent vasovagal
reactions but do nothing to prevent pain from needle insertion.
Self-Relaxing Techniques
Some needle phobic patients are able to reduce their anxiety by self-relaxation
techniques. These techniques slow the heart rate, lower the blood pressure, slow the
breathing rate, increase blood flow to major muscles, improve concentration, reduce
anger and frustration, and boost confidence to handle problems. Overall, self-relaxing
techniques refocus the individual’s attention to something calming. It does not matter
which technique is used but the technique should be practiced regularly to reap the
benefits. Examples of relaxation techniques follow.
Autogenic Relaxation: Both visual imagery and body awareness are used to reduce
stress. The individual repeats words or suggestions in his/her mind to help relax and
reduce muscle tension. The individual imagines a peaceful place and focuses on
controlled, relaxed breathing, and slowing of the heart rate.
Progressive Muscle Relaxation: The individual focuses on slowly tensing and then
relaxing each muscle group. Some individuals start at the head and work down; others
start at the feet and work up. The muscles are tensed for at least 5 seconds and then
relaxed for 30 seconds.
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Visualization: The individual forms mental images and takes a journey to a peaceful,
calming place. The individual uses as many senses as possible including smell, sight,
sound, and touch. For example, the individual could imagine himself at the beach,
hearing the waves come in and out, feel the sand under his toes, and smell the salt
water.
Distraction
For children and mild needle phobics, distraction techniques can help with anxiety
associated with needle procedures. Children can be distracted with books, noisy toys
(the noisier the better), and playing with dolls or stuffed toys. Adults can be distracted
by watching a video, bubble/lava lamps, listening to soothing music, or looking at
pleasant, calming pictures on walls.
A study conducted by the Department of Internal Medicine at the University of New
Mexico in Albuquerque demonstrated that adding decorative designs or stickers to
syringes and blood collection equipment significantly reduced aversion, fear, and
anxiety among needle phobic patients and children. The syringe barrels and winged
infusion sets were decorated with various types of stickers. Syringes decorated with
musical notes, flowers, and smiley faces were most favored. The winged infusion sets
decorated with butterflies, flowers, fish, and smiley faces were most liked. The
decoration of these medical devices is thought to stimulate brain areas not associated
with fear and anxiety.
The Wand®
The Wand® (Milestone Scientific) is a dental tool that virtually guarantees painless
injections for dental work. It is a computer-controlled injection device that provides
precise control of the flow rate of the anesthetic agent. The device looks like a ballpoint
pen that is attached to a piece of equipment that looks similar to a miniature computer
tower. The Wand® is used after the injection area in the mouth has been numbed with
a topical anesthetic. Many needle phobics sing the praises of what they call “The Magic
Wand!”
Psychological Assistance
Desensitization techniques used by psychologists and psychiatrists to treat many types
of phobias may be useful for some needle phobic individuals. This technique should
only be used by trained professionals as the treatments could cause serious reactions
in the patient triggered by the needle phobia. Desensitization techniques are not as
successful for treating needle phobics as they are for treating individuals with other
types of phobias.
The goal of successful desensitization is to provide the patient with relaxation
techniques to use when undergoing a needlestick procedure so the patient experiences
minimal or no anxiety. Desensitization may take weeks of intensive therapy.
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Desensitization techniques generally have the following steps. The healthcare
providers must watch the patient carefully through these steps as a vasovagal reaction
may occur. Steps may be started and stopped as many times as necessary for the
patient to become comfortable with the equipment.
Step 1: Recognition and relaxation. Using an anxiety scale of 0-10 (10 being severe
anxiety), the psychologist/psychiatrist evaluates patients at risk. If an anxiety score of 3
is identified, they discuss the needlestick procedure in detail to assist in alleviating the
fear of the unknown. Distraction and relaxation methods are discussed and practiced.
The healthcare provider may recommend hypnosis.
Step 2: Control and Preparation. The healthcare provider encourages patients to
participate in decision-making and to optimize ways to relieve anxiety. Patients are
encouraged to talk about their concerns and ask questions related to the procedure.
Patients can choose their own environment and have a support person to stay by their
side. Developing a sense of control assists patients in minimizing their anxiety.
Step 3: Graded Exposure. In this step, patients are gradually exposed to the
equipment used for the needlestick procedure. At first, toys, videos, and pictures may
be used to illustrate the procedural steps. Next, patients look at and handle the
actual equipment to be used such as an alcohol wipe, local anesthetic gel, syringe
needle, syringe, vaccine vial, etc. Eventually the healthcare provider performs the steps
in the needle procedure without actually performing the needlestick. The capped
needle can be placed on the skin and a puncture mimicked. When the patients become
comfortable with this, they are ready to move on to the actual procedure.
The Virtual Reality Medical Center (www.vrphobia.com/) has a virtual doctor’s office
where the patient is gradually exposed to experiences that cause anxiety in carefully
controlled stages.
Prevention of Needle Phobia
Due to the genetic component, not all needle phobias can be prevented. However,
inappropriate care provided by healthcare providers that can result in needle phobia in 1
out of every 10 patients can be prevented. Improved care can even assist as many as
50-70% of needle phobics in dealing with their anxiety. The following suggestions are
recommended for the prevention of needle phobia.
Healthcare personnel should identify individuals at risk for needle phobia at the
time of scheduling an invasive/painful procedure and not at the time of the actual
procedure.
Healthcare providers should ask the patient (or the parents of a child) if he/she
has unusual sensitivity to pain and if he/she has exhibited needle phobic
reactions during previous procedures.
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Healthcare personnel should ask if the patient has ever fainted when anxious or
for no known reason.
If the patient has experienced a vasovagal reaction (fainting or near fainting),
healthcare providers must be prepared for the reaction to happen again. The
procedure should be performed using all available methods to prevent vasovagal
reactions, as previously discussed.
Healthcare providers must assure that the patient’s first few needle procedures
are good experiences. Patients identified as high risk for needle phobia should
be administered topical anesthesia and precautions used to prevent vasovagal
reactions.
Patients should never be ridiculed for being afraid or emotional about needle
procedures. They must be treated with empathy by all healthcare providers.
Healthcare providers must be honest with patients and their families. Painful
procedures should not be spoken of dishonestly with phrases such as “This won’t
hurt a bit” or “You will just feel a pinch.” Many needle phobics can trace their
fears to situations in which they believe healthcare professionals lied to them.
This made them feel confused, then angry, and ultimately, distrustful. Healthcare
providers should not exaggerate the pain but they should not dismiss it as
painless.
Healthcare providers should allow patients as much control as possible as soon
as possible. When patients feel in control, it provides them a level of comfort.
CONCLUSION
For many individuals, needle phobia causes them to avoid all types of medical and
dental care. This phobia presents a widespread public health challenge since these
individuals may avoid necessary medical care. This course has discussed types,
causes, management, and prevention of needle phobia.
REFERENCES
2010 ICD-9-CM Diagnosis Codes: Anxiety, dissociative and somatoform disorders.
www.icd9data.com. 8 December 2009
A Fear of Needles: Case Study. www.dentalphobia.co.uk. 17 December 2009
“Hospital Life”. Children in the Hospital. Great Ormond Street Hospital. Children First
for Health. 14 September 2007 http://www.childrenfirst.nhs.uk/kids/hospital/.
“Managing Diabetes.” West Suffolk Hospitals. www.diabetesuffolk.com. 14 September
2007 http://www.diabetesuffolk.com/ManagingDiabetes/default.htm.
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“Phobias.” MayoClinic.com. 10 December 2009
http://www.mayoclinic.com/health/phobias/DS00272.
“Relaxation Techniques: Learn ways to reduce your stress.” MayoClinic.com. 10
December 2009 http://www.mayoclinic.com/health/relaxation-technique/SR00007.
“Muscle Tension to Prevent Reactions: Leg Lifts.” Kennesaw State University. 8
January 2010 http://www.kennesaw.edu/stu_dev/vksu/pdf/prevent_reaction.pdf
“Needle Phobia.” Dental Fear Central. 3 December 2009
http://www.dentalfearcentral.org/needle_phobia.html.
Hamilton, James G. “Needle Phobia: a neglected diagnosis.” 8 August 1995. Journal of
Family Practice. BNET. 18 May 2007
http://findarticles.com/p/articles/mi_m0689/is_n2_v41/ai_1727659/print.
“New Study Finds More Than 20 Million Americans Suffer From Belnophobia.” 14
December 2006. RedOrbit. 8 December 2009
http://www.redorbit.com/news/health/767251
Philipkoski, Kristen. “Nixing the Need for the Needle.” 28 March 2006. Wired. 14
September 2007 http://www.wired.com/medtech/health/news/2006/03/70363.
Kettwich, Sharon C, et al. “Patients with needle phobia? Try stress-reducing medical
devices: a randomized controlled trial comparing decorated and plain syringes and
butterfly needles.” 1 August 2006. Journal of Family Practice. BNET. 14 September
2007 http://findarticles.com.
Lamb, D. Keith. The Needle Phobia Information Center. 8 December 2009
www.needlephobia.info.
“The Wand® (CompuDent or STA system).” Dental Fear Central. 20 January 2010
http://www.dentalfearcentral.org/wand.html.
Fear of Needles and Blood. Virtual Reality Medical Center. 14 September 2007
www.vrphobia.com.
Emanuelson, Jerry. “Welcome to the Needle Phobia Page.” 14 September 2007
http://www.futurescience.com/needles.html.
Muscari, Mary E. “What Can I Do to Help Patients with Belonephobia?” 15 January
2010 www.medscape.com/viewarticle/555513_print.
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TEST QUESTIONS
Needle Phobia #1222614
Directions:
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1. A phobia is a type of __________ disorder.
a. anxiety
b. compulsive
c. manic
d. schizophrenic
2. Categories of phobias include __________.
a. agoraphobia
b. social
c. specific
d. All of the above
3. Which of the following is a reaction exhibited by a phobic individual who has
encountered the object or situation of his/her phobia?
a. Decreased heart rate
b. Fainting
c. Headache
d. Strong urge to control the situation
4. Which of the following is a type of social phobia?
a. Fear of heights
b. Fear of humiliation
c. Fear of open spaces
d. Fear of snakes
5. The medical term for needle phobia is __________.
a. aichmophobia
b. algophobia
c. belonephobia
d. trypanophobia
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6. How many blood draws and injections are estimated to be performed daily in the
United States?
a. 9,000
b. 1,000
c. 190,000
d. 900,000
7. Which of the following is the most common form of needle phobia?
a. Acute sensitivity to pain
b. Classic needle phobia
c. Fear of the unknown
d. Vasovagal reflex reaction
8. Which of the following is a symptom of a vasovagal reflex reaction?
a. Extreme sensitivity to pain
b. Fainting (syncope)
c. Skin rash
d. Tachycardia (rapid heart beat)
9. What percentage of needle phobic patients have a first-degree relative with a needle
phobia?
a. 8%
b. 28%
c. 68%
d. 80%
10. Which of the following is NOT a clinical finding seen when a needle phobic
patient is exposed to a needle?
a. Abnormal electrocardiogram results
b. Decrease in stress hormones
c. Nausea
d. Sweating
11. Needle phobia is thought to have an inherited and __________ component.
a. familial
b. genetic
c. inborn
d. learned
12. Both needle phobic patients and healthcare providers must communicate
effectively to assure the most appropriate care is given.
a. True
b. False
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13. Which of the following is recommended when performing a needlestick procedure
on an individual who has a history of vasovagal reactions (fainting)?
a. Elevate the legs.
b. Provide a warm blanket.
c. Use iontoporesis.
d. Use topical anesthetic.
14. Which of the following topical anesthetics is NOT approved by the FDA for
use in the United States?
a. Ametop® Gel
b. EMLA®
c. L.M.X.4®
d. Zingo®
15. The use of iontophoresis to deliver topical anesthesia provides better pain
relief than topical application because __________.
a. It is a less expensive procedure.
b. It drives the topical anesthetic deep into the skin.
c. It works quicker than the other topical anesthetics.
d. There is no type of equipment involved.
16. An example of an iontophoretic topical anesthesia is __________.
a. Ametop® Gel
b. EMLA®
c. Numby Stuff®
d. SonoPrep®
17. Alternative methods of medication delivery include all of the following
EXCEPT __________.
a. adhesive patches
b. iontophoresis
c. nasal sprays
d. sublingual
18. Applied muscle tension consists of __________.
a. crossing legs or leg lifting during a needle procedure
b. taking anti-anxiety or sedative drugs prior to the needle procedure
c. using massage therapy to relax the needle phobic’s muscles
d. using the needle phobic’s senses to visualize a peaceful place
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19. Desensitization techniques used by psychologists and psychiatrists are a
very successful treatment for needle phobic patients.
a. True
b. False
20. Which of the following happens in Step 2 of the desensitization treatment?
a. The anxiety level of individuals at risk is identified.
b. The patient develops a sense of control to minimize his/her anxiety.
c. The patient is gradually exposed to needlestick equipment.
. d. The patient learns to use relaxation techniques.
21. Which of the following is recommended to help prevent the development of
needle phobia?
a. Healthcare providers should ask if the patient has fainted, felt anxious, and/or
is extremely sensitive to pain.
b. Topical anesthetics should be used if the patient is identified as high risk for
needle phobia.
c. Healthcare providers should treat all individuals who have anxiety and/or fear
with compassion and empathy.
d. All of the above are recommended.
22. Improved care can assist as many as __________ % of needle phobics in dealing
with their anxiety.
a. 10-15
b. 20-40
c. 50-70
d. 90-100
*end of test*
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Course Title: Needle Phobia Course Number: 1222614
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