D. Keith Lamb The Needle Phobia Information Center Columbus, Ohio 43221 USA Email me by clicking below Last update: 2012, Jan 16   Welcome to... The Needle Phobia Information Site If you (or a loved one) are terrified of needles... you are not crazy... it isn't a character flaw...and you are certainly not alone... there are many people just like you, in fact there are millions of them! You have come to the right place if you want to find information on this defined medical condition (DSM-IV 300.29), learn about treatments and resources, and read stories of many others who have suffered from this exasperating condition, just like you.  You'll learn that you too can conquer Needle Phobia. So what's this condition called?  Take your pick...      Belonephobia:fear of needles   Aichmophobia:fear of pointed objects        Algophobia:fear of pain  Trypanophobia:fear of injections Let's get something straight here, if you have an extraordinary fear of needles, medical procedures, blood/injury, or pain, you are not a whimp, you are a 'special need' patient, your fear is not a character flaw, nor does it have anything whatsoever to do with lack of will power.  You are a special-need patient.  Don't forget it and don't let anyone else forget it.    Contents: Jan 2012 - we just changed web hosts - please bear with us as we fix a bunch of broken links... Thanks for the free hosting of the NeedlePhobia Information site goes to 000webhost.com - check them out at http://www.000webhost.com/features NEW: dermal anesthesia products for needle phobes: Lidosite, Gebauer's Vapocoolants, and Vibroject for dental injections Definitions and my story, confessions of a world-class Needle Phobe Discussion of the Types and Causes of Needle Phobia  Table of Manifestations, Causes, and Tx Strategies A Step-by-step Guide to Conquering Needle Phobia Needle phobics are made, not born...preventing needle phobia A challenge to parents and health care professionals List of Risk Factors for Developing Needle Phobia Finding the Right Physician Needle Phobia Links and Journal Articles  Vicarious Needle Phobia - a Mighty  Strange Manifestation Hear the Stories from Needle Phobics and Their Loved Ones Description of Treatments Summary Table of Treatments for Needle Phobia Contact Me What motivated me to go public with my fear How to use Life-Tech's NeedleBuster for topical anesthesia Some words for women needle phobes regarding pregnancy Click here to download a copy of Dr. James Hamilton's landmark journal article DK Lamb Bibliography/Needle Phobia publications Links Legal Notice

My story:

No, you are not alone.  But I alone claim title to the world's worst needle phobe.

First, lets get some definitions straight.  I have read many publications and web sites which claim to label Needle Phobia with some technically correct  million-syllable medical term.  For my money, the correct term for what I'm describing is  Belonephobia, which is Greek for "Fear of Needles".  It is pronounced: Bel-o-ne-phobia.  I used to pronounce it Be-lone-e-phobia because it was easy to remember, after all, my family and colleagues always described my fear as 'full of boloney".  Anyway, the correct pronunication starts with "bell-o".  

Here are some related terms you will hear, just for the record:

Aichmophobia: fear of pointed objects
Algophobia: fear of pain
Trypanophobia: fear of injections

I have spent thousands of dollars and years of torment trying to solve this problem so I could have even the most basic of medical/dental care. I was 37 years old before I could get enough courage to have a blood test.

I trace my phobia all the way back to childhood inoculations. It was an experience from hell. I was treated like a baby and a whip - doctors insulted me for being so uncooperative. I distinctly remember being restrained and forced to undergo needle punctures.

What good does it do a child's health to prevent measles only to have them die later from septicemia because they refuse to have their impacted teeth removed? I believe that the medical community is equally clueless as to the damage they do from painful procedures. They never see the end results of not providing adequate anesthesia and anxiety control.

I receive messages weekly from worried patients and mothers. In some cases the patients are near death and refuse all care because they are just too afraid.  And a few of them die - not directly but indirectly - because they cannot access life-saving medical care.

During my multi-decade search for a solution, my objectives have been:

1) To keep my ear to the ground on the latest medical findings and developments in the hope that a new solution to my problem has been developed;

2) to be open to identifying and trying non-traditional approaches;

3) keep an open-mind to finding that one-in-a-million physician who will damn the torpedoes and help me.

I believe I have tried everything available. Most needle phobes are actually afraid of the needle itself, rather than the pain. For me, it was pain...pure and simple.

I am convinced that the technology exists today to 'solve' this problem. The challenge is to find a legitimate way to access that technology.  The ultimate challenge is to understand this fear well enough that it can be prevented.

A word on alternative therapies: I have tried quite a few alternative therapies (non-drug) because I wanted something that put me in control.  With drugs, I had to beg physicians to write prescriptions.  I could not control my own care due to the fact that physicians have an absolute monopoly on prescribing powers.  It was easier for them to just do nothing and tell me to just 'be brave' than to try to deal with this pesky problem.

Here is a list of some of the non-drug therapies I have tried:

- Hypnosis
- Cognitive Behavioral Therapy
- Meditation/Relaxation
- Visualization/distraction/imagery
- Rational Emotive Therapy (RET)
- Exercise
- Physical therapy
- Chiropractic
- Thought field therapy (TFT)
- Herbal anti-anxiety formulations

These techniques were, frankly, total duds...no detectable improvement whatsoever. I gave these therapies every chance and spent a small fortune on them. I have heard that some of these have helped some people, but most of the people I hear from had the same experience I had. Please note this may be because those who's problem was amenable to these therapies probably never contacted me so I only tend to hear about the failures.

The only alternative therapy I haven't tried is acupuncture. It is amazing how many people recommend acupuncture for needle phobics. Go figure!

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Discussion of the types and causes of needle phobia:

The risks are no laughing matter to the needle phobic patient...
or the babies of pregnant needle phobes.

Most needle phobes, their families and yes even their physicians, do not realize that this phobia is quite distinctly different than other phobias.  Unlike other phobias, this is a fear that can be lethal.   Patients can die from either direct and in-direct causes. While we have no way to know how many patients die from the indirect cause - the avoidance of needed medical care - we do have medical literature (Hamilton) documenting the death rate from the direct cause of a sudden plunge of blood pressure from a reflex called Vaso-Vagal Syncope or VVS (pronounced Vase-Oh-Vay-Gal Sin-Ko-Pee).  Lethal VVS in needle phobes is rare, thankfully, accounting for only a few deaths a year in the US.  Dr. James Hamilton, the family practice physician who wrote the definitive journal article on needle phobia, lost his father to VVS.
 

Unlike other phobias, needle phobia is a fear that can be lethal.

So we see that needle phobia is no laughing matter!  There is a significant risk to the life and health of a needle phobe from avoidance of medical or dental care.  And let's not forget the risk to unborn babies in the case of pregnant needle phobic women.  There is even a documented case in which a needle phobic expectant mother was permitted by the court to risk the life of her unborn child by refusing a C-section due to needle phobia [Clare Dyer.  Appeal court rules against compulsory cesarean sections. BMJ 1997; 314: 993]

For decades before I started an all-out mission to understand my affliction I had just assumed that the cause of the needle phobia centered around the very natural fear of pain.  I was surprised to discover that fear of pain is not at all a common concern amongst needle phobes.  In fact a majority of serious needle phobes would opt for a more painful approach if it could avoid the needle!  Well 'surprise' isn't the word for what I felt when I discovered this...shock was more like it.

The fear of pain is surprisingly not a common concern for needle phobes.  Many serious needle phobes would opt for a more painful approach if it could avoid the needle!

Intrigued, I began my search by reviewing the medical literature  -  a task which proved quite easy given the limited amount of published information on the subject.  Fear of pain from invasive medical procedures didn't show up in any of the medical literature on the subject as an identified cause of this condition.  There were various causes and implications given in the literature but I could not find any direct study done with the specific goal to ascertain the underlying cause(s) of needle phobia.

Next, I started this web site and welcomed fellow sufferers and their loved ones to contact me.  I would then ask them to think carefully about exactly what it was that they feel is the cause of their fear.  I would ask a question such as "what is it about needle procedures that makes you fear them?".   Typical responses included "I never thought of the WHAT or the WHY before" and "I have no idea of why I am afraid".   I would clarify my question and respond with "...not WHY are you afraid, but WHAT are you afraid of?".  

An unscientific survey for sure, but still enlightening...

I saved every letter, every response, and archived all the newspaper, magazine, and literature articles I could find for almost 4 years (and I'm still at it).  I would even ask patient's to have their loved ones write to me privately and give me their view of what their needle phobic loved one was really afraid of.  I also had a number of very long telephone conversations with some of the more serious cases. After I had collected information on about 500 needle phobic patients, I then merged the common threads with the published causes.  Strange hobby, huh?

While I am still collecting this information the patterns are now repeating themselves.  In the last year I have only heard from one patient who stated anything about their fear that I hadn't heard before so it is a reasonable conjecture that I've heard from a wide enough sample to get a picture of the needle phobia landscape.   

There are, at least, 4 very distinctly different manifestations of needle phobia.  This is a critically important fact because the treatment strategies are different for each one.   If you don't identify the underlying cause of needle phobia correctly you will mis-fire when you go to treat it.  And if you are a particularly unlucky soul, you could make the condition worse.

Below is a table which summarizes what I have so far.  The literature estimates that 10% of the US population is needle phobic (Hamilton).   I then categorized each needle phobe's own assessment of what they fear.  To get some idea of the prevalence of each type of needle phobia I then multiplied the ratio of each type of needle phobia in my survey with the 10% overall affliction rate.  So if half the needle phobes are afraid of the same thing, then it follows the prevalence of this particular fear in the general population is 5%.  

Although the prevalence rates are small, on order of just a few percent, we need to keep in mind that this still represents a very large number of human beings - over 20 Million in just the US.  At this point I'd have to say that for such a clinically important condition affecting tens of millions of patients it is shocking that so little attention is paid to this in the medical or popular literature.  And that's to say nothing of how little attention medical professionals pay to it!

It is shocking that so little attention is paid to such a clinically important condition affecting tens of millions of patients.

 

Needle Phobia Manifestations
Suggested Causes and Treatments

Needle Phobia Type	Primary Symptoms	Patient fears...	Cause	Reference	Treatment Strategy	Therapy	Prevalence % population Proportion of needle phobes
Vaso-Vagal	Fainting, sweating, nausea, initially high blood pressure and heart rate, followed by a sudden precipitous plunge in blood pressure; patient tends to react passively	the thought, sight or feeling of needle-like objects (and sometimes blood also).	Inherited Reflex	Hamilton	Desensitization	Progressive exposure techniques; avoid visual exposure, provide anesthesia so patient cannot feel needle.	5% about half of all needle phobes
Associative	Extreme unexplained anxiety, difficulty sleeping and preoccupation with approaching procedure.	sub-consciously  associated traumatic event.  This includes fear transferred from parents or siblings who exhibit intense negative reactions to needle/medical procedures.	Emotional trauma (usually in childhood) associated with a medical/needle procedure		De-link needle procedures from the underlying associated fear.	Cognitive therapy,  hypnosis, NLP, etc. Anti-anxiety medications may be helpful.	3% 3 out of every 10 needle phobes
Resistive	Combativeness high heart rate and high blood pressure, violent resistance, avoidance and flight	being controlled.	Repressive upbringing, poor handling of prior procedures (forced with physical or emotional abuse)	Trijsburg, et. al.	Put the patient in control	Psychotherapy, teach patient self-injection techniques; find trusted provider	2% 2 out of every 10 needle phobes
Hyperalgesic	Extreme  explained anxiety and elevated blood pressure and heart rate at the immediate point of needle penetration or seconds before.	Pain. These patients cannot understand how anyone can tolerate needle procedures and they are therefore quite aware of exactly why they dread such procedures	Inherited pain sensitivity	Uhl, et. al. Leutwyler Zubietar	Provide pain relief	Anesthesia, topical or general	1%  1 out of every 10 needle phobes

 

click here to download a printer friendly version of this table (in PDF Acrobat Format):

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A step-by-step guide to conquering your needle phobia:

Effective treatment of needle phobia is very much dependent upon the underlying cause, unlike many other simple phobias.   From my experience, it is very helpful to know why you are afraid of needles in order to begin the process of conquering your fear.   What's really incredible about this condition is that the vast majority of the people I hear from report that they really don't understand why they are afraid of needles - they seem perplexed and sometimes embarrassed.  All this means is that they just simply don't understand the underlying cause of their fear.  They don't know what they are really afraid of, much less why.

I cannot emphasize strongly enough that without knowing where you are,  you cannot effectively pave a path to freedom from this phobia.  If you just blindly move forward pursuing every therapy known to mankind, including all natures of weirdo things that friends and family might suggest, you my friend are in for a very long, frustrating, and expensive undertaking.

It is much better to come to grips with the cause and nature of your fear first.  Then, your path to success will be much more clear and direct.  So, let's get started...

1) Ask yourself this important question: "That would need to be different about the experience of needle sticks in order for me to accept them without disabling pain, fear, or anxiety?"

This may sound like a stupid question.  Your knee-jerk reaction might be "duh! What would have to be different is that I don't want a needle stuck into me!".  Ok, that's a valid response.  There are ways to accomplish almost all needle procedures without actually using a needle.  But be careful - do not be so hasty in answering this.  What if there were a way to have a procedure done without a needle (such as a blood draw), but it required the use of a technique which was risky and more painful?  If you really are just afraid of needles, then you might opt for such alternative procedures.   But if you are afraid of pain, like me, then the alternatives might be worse.

 So, take a very long and careful look at question #1 before you move on.

 2) Next, ask yourself "When did I first realize that I had this problem and what do I think caused it?"

Needle phobics are made, not born...preventing needle phobia:

While most of my focus has been to understand the causes of needle phobia in hopes that more specific and effective treatments could be found, it is helpful to say a few words about what actually starts the fear in the first place. There are several inherited factors which pre-dispose a patient to developing needle phobia.  But it is not a given that such patients will necessarily develop an intense fear which will harass them and block medical/dental treatment for the rest of their life.  It is the combination of predisposing factors, environment, and how they are treated by parents and health professionals which creates needle phobics.  

In other words, needle phobics are made, not born.  This means that if parents and health care professionals knew how to better handle patients, most if not all cases of life-long needle phobia could be prevented.  This is especially important during those all-important first few contacts with the health care system in young patients.  The most critical thing health care professionals need to know is which actions initiate needle phobia in predisposed individuals.  

If they were sensitive enough to the patient they could even direct active efforts to prevent needle phobic.   Come to think about it...aren't those first experiences with young patients usually those in which they are to receive invasive/painful procedures such as inoculations? So let's say it this way: the first few encounters that a young patient has with the health care system that involve invasive/unpleasant/painful procedures need to be handled in special ways. Here are some suggestions for parents and health care workers:

A challenge to Parents and Health Care Professionals A set of standardized care techniques is presented here to help prevent induced needle phobia in young patients
A small majority of needle phobics were genetically predisposed to develop this potentially fatal condition.  The remainder develop it as a result of negative experiences with the health care system.   The majority, if not all of the cases, can be said to be instigated or induced by inappropriate care during their first encounters with the health care system.  The techniques described here may seem extreme considering that only about 10% of patients develop needle phobia.  The special care suggested is justified considering the severe negative consequences of needle phobia. Parents and health care workers need to understand that their actions induce or trigger the development of this phobia - it is not the result of a weakness in the child's emotional constitution as has been assumed for so long.  A potentially life-long condition that causes such severe suffering and can even be fatal that is induced by inappropriate care in one of out every ten patients is simply worth the small extra effort required to prevent it.   The many protocols used in modern medicine that we now take for granted were historically developed when understanding of the cause of induced illness became clear.  The importance of sterility in surgery is a good example.  No doubt when first proposed many practitioners felt that sterile fields were far too difficult, time consuming and expensive to be practically implemented.  The cost of these precautions cannot be weighed unless the consequences of not implementing them is fully appreciated.  The cost of needle phobia has not been appreciated until now because the consequences often do not become apparent until long after the affected patients have left the care of the original practitioners who's treatments helped induce their condition. While 10% of patients would benefit immensely from avoiding needle phobia, as many as 50-70% of other patients would still benefit to some degree from improved care even if they avoid developing clinical needle phobia. Below are improved care suggestions for both parents and health care providers (including dentists) that will go a very long way to helping prevent needle phobia.  Other forms of blood/injury phobia might benefit as well from these care suggestions:
1.	Identify those children who are to receive their first invasive/painful procedure, preferably at the time the appointment is made - avoid having to deal with it during the first appointment.
2.	Survey parents and siblings in order to discover whether they may have exhibited needle phobic reactions.
3.	Ask the parents whether the child has exhibited unusual sensitivity to pain.
4.	Find out if the child has ever fainted upon exposure to fearful stimuli or has fainted for no known reason.
5.	If a vaso-vagal reaction is suspected or experienced during the first needle/blood exposure then it should be treated before any more such procedures are attempted.  A tilt-table test may be indicated.  If the reflex cannot be eliminated then all future invasive procedures need to be handled in a way very different than other patients, up to and including the use of general anesthesia.  Procedures which stimulate the reflex should only be attempted in facilities staffed and equipped for cardio-pulmonary resuscitation.
6.	If associative fears are detected then professional emotional health treatment may be indicated prior to proceeding with any invasive/needle procedures.
7.	The first few procedures are so crucial that they need to be the best health care experience of the child's life, not the worst.  This justifies the prophylactic administration of topical anesthesia such as EMLA or iontophoresis whether it is known to be needed or not.  The first few needle sticks need to be absolutely painless.  Let the patient's reactions be the guide as to if or when anesthesia can be reduced or eliminated.
8.	It goes without saying that there is no room in the child's first exposures to health care for any negative emotional coercions or punishments such as ridiculing the child for resisting fearful or painful procedures. Treat the cause of the resistance, not the resistance itself.
9.	Restraint: A child should not be physically restrained or otherwise forced to undergo elective invasive/painful/needle procedures.  "Elective" means a procedure which is not immediately required to save life, limb, or preserve long-term health.  Even necessary procedures should usually not be forced on children with the possible exception of those patients who are mentally impaired or are so young that they effectively are unaware.  (Note: there is growing evidence that even painful procedures performed at the age of a few days is emotionally harmful and is remembered).  When necessary, care for the very young or mentally impaired, medication (pharmacological restraint) might be a better approach.  Emotional restraint such as purposeful embarrassment, insult, or threat of punishment is harmful and should not be used.
10.	Health care workers must be completely honest with parents and patients.  There is no room for hiding the truth even if the intent is to be helpful.  Painful procedures should not be untruthfully described with phrases like "this won't hurt a bit".  When a patient experiences pain after being told a procedure won't be painful they feel confused, have self-esteem challenges, and ultimately become angry and distrustful.  Many needle phobics trace their life-long distrust of health care workers to "being lied to" when they were young.  Even euphemisms should be avoided such as "you might feel some pressure".  Pressure and pain are different things - don't confuse them.  While you should not exaggerate the discomfort, keep in mind that it is much easier to harm a child when using half-truths, untruth's, and mistruths than by undo frankness.
12.	If the child is too young to understand then take actions to make procedures physically painless and health care encounters as emotionally free of stress as possible until such time as they are mature enough to understand what is happening.  A big helping of emotional support and praise goes a long way.
13.	The goal is to make encounters with the health care system non-tramatic and to build the perception that health care is good and the workers involved are friends.  You know you are moving in the right direction when each encounter with the health care system is less stressful rather than more stressful.  If the child is more stressed and expresses increasing resistance with each health care encounter, then you are moving in the wrong direction and you should stop and re-assess your approach.
14.	Start by using anesthesia (like EMLA cream) so that the first procedures will be painless.  One recommendation for future procedures is to ask the child if and when they want to stop using the 'messy' cream or an iontophoresis machine.  Be honest - tell them it will then hurt a bit, but for only for a few seconds.  Tell them if it hurts too much, they can ask for the cream the next time.
15.	Give the child as much control as possible as soon as possible.  It will serve them well for the rest of their life.

               

Click here to download a printer friendly version of this table (in PDF Acrobat Format):

 

 More often than not, people report the same cause that I had, namely, being forced by restraint to undergo childhood inoculations, dental work, and such. Needle procedures forced under restraint is one of the most commonly cited initiation factors of needle phobia.  Please note that the 'restraint' can be physical or emotional.  I could not exaggerate the number of needle phobes who tell me that their greatest frustration of this condition is being called a 'baby' or a 'whimp' or other insulting label by friends, family, or medical personnel.  This would indicate some form of restraint was involved in the beginnings of their phobia, probably an emotional restraint by a parent.

Some common risk factors for the development of needle phobia

 

Many severely needle phobic individuals have one or more of these risk factors:

1. History of being restrained (especially at a young age) while being forced to undergo needle punctures or other painful procedures 2. Painful past experiences with needle sticks 3. Extreme pain sensitivity (known medically as hyperalgesia) 4. Feeling of a loss of control (see #1 above) 5. Instinctive repulsion at objects being stuck into/through the body 6. Being influenced by the similar pain or fear of a parent or sibling 7. Genetic pre-disposition to vaso-vagal syncope

For example: what if a needed blood test or injection could be done without a needle (but not necessarily without pain); what if it could be done in a way in which it was not possible for you to see the needle?  What if there was a way that you wouldn't see OR feel the needle?  What if you were asleep during the procedure (sedated or under general anesthesia).  Don't hold back from this...use your imagination....come up with SOME circumstance under which it would work for you.  Sure, its possible that no technology exists to accomplish what you come up with, but that's not the point of the exercise.  Once you can identify the circumstances under which you could get the tests done comfortably, you will have a clue as to what you fear.  The next step is to work on the fear.

 Here is how my analysis worked out:

   "I do best when I can see the needle...I get REALLY anxious when I don't know when its coming at me.  Since doctors/nurses cannot perceive how much it is hurting me and since I don't trust them to stop if the pain is too great, I'd prefer to give the needle stick to myself.  I've tried, but it is so painful I cannot accomplish giving myself a needle stick.  I know I can have needle-sticks if it just didn't hurt.  I would have no problem at all if it I couldn't feel anything or if I were asleep (under general anesthesia). " 

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Finding the right physician: Legal liability, and accessing medications: The big problem with drugs is that you have to convince (translation: beg) physicians to write prescriptions.  Since physicians in our society have an absolute monopoly on prescribing powers (a barrier which did not always exist by the way),  needle phobe cannot take charge and control the pursuit of a solution if medications are needed.  Rather, it is the physician who will control the progress of the search.   It is therefore vital to the project to find the right physician.

  
Example: while myself and various therapists have come up with a number of promising pharmaceutical approaches, neither they nor I could access the medicines without having first found and convinced a licensed physician to cooperate with our plan.  Unfortunately, most physicians will not cooperate.  It is far easier and less legally risky for them to just do nothing.  In practice finding the right physician means that the physician must be made to feel medically and legally comfortable as well as adequately compensated to participate in the care of a needle phobic patient.

So here are some ugly facts of life which needle phobes must face in their pursuit of a physician:

1) A physician usually has to practice outside the 'standard of care' when treating a needle phobe.  In fact they must operate to some degree outside their scope of practice - a very risky venture legally speaking.  I cannot think of any practitioner who's scope of practice clearly includes the types of therapies that a needle phobic patient may need....so all physicians would have to operate to some degree outside the scope of standard care and their own practice.  A patient simply cannot sign enough waivers to materially deflect this special degree of risk that a physician takes on when dealing with a needle phobic patient;

In the case of needle phobia, being a 'special need' patient often translates into being a 'special risk' patient.

2) there is no practical way for a patient to throw enough money at a physician to make them feel adequately compensated to take on the risk of treating a needle phobic patient.  And that's not to mention that the patient is usually on their own financially in this regard because insurance companies will not participate in dealing with this affliction as a 'special need' of the patient.  

If you need unusual approaches to treatment and/or especially high doses of strong medication to deal with your needle phobia, you should understand that you are essentially asking the physician to risk his livelihood for a $50 office call.

Finding a sensitive, understanding, cooperative and helpful physician is one of the needle phobes' most basic and challenging barriers to treatment.  While it is true that very few physicians are knowledgeable about needle phobia, lack of knowledge isn't usually the problem.  And since we have already said that a patient cannot compensate the physician enough for the special risk involved, a physician treating a needle phobic patient needs some very unique credentials - they need a truly rare set of initials after their name: I-C-A-R-E.  

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Resources:

Literature references:

Dennis J. Ernst.  "What You Need to Know About Needle Phobia" Center for Phlebotomy Education.

Ranit Mishori, MD. No, No, Not the Needle! For Some Patients, Fear of Medicine's Most Pointed Treatment Is No Joking Matter includes interviews with Dr. James Hamilton and DK Lamb. The Washington Post, Tuesday, April 13, 2004

I highly recommend you visit Jerry Emanuelson's Needle Phobia Page for some background info.  

Visit New York City dentist Dr. Louis Siegelman's Dental phobia web site for information on dental care for apprehensive patients.

Hamilton, James G.  Needle Phobia: A Neglected Diagnosis. The Journal of Family Practice.  August, 1995. [Vol. 41, No.2, pp. 169-175].  This is the landmark medical paper on the subject of needle phobia.  Click on the article title to download a copy.

Ellingwood, Everett H., Hamilton, James G.  Case report of a needle phobia. The Journal of Family Practice.  April, 1991. [Vol. 41, No.2, pp. 169-175].  This is the landmark medical paper on the subject of needle phobia.  Click on the article title to download a copy.

Trigwell PJ. Iatrogenic Needle Phobia. [Letter]. Br Dent J 1993;174:158.

Deacon B, Abramowitz J.  Fear of needles and vasovagal reactions among phlebotomy patients.  J Anxiety Disord. 2006 Feb 3.

Nir Y, Paz A, Sabo E, Potasman I.  Fear of injections in young adults: prevalence and associations.   Am J Trop Med Hyg. 2003 Mar;68(3):341-4.

Kleinknecht RA. Acquisition of blood, injury, and needle fears and phobias. Behav Res Ther 1994;32:817–23. 

Thurgate C, Heppell S.  Needle phobia--changing venepuncture practice in ambulatory care.   Paediatr Nurs. 2005 Nov;17(9):15-8.

Hart PS, Yanny W.  Needle phobia and malignant vasovagal syndrome.  Anaesthesia 1998 Oct;53(10):1002-4. 

Majstorovic M, Veerkamp JS.  Relationship between needle phobia and dental anxiety.   J Dent Child (Chic). 2004 Sep-Dec;71(3):201-5.

Praveen P. Fernandes, M.D.  Rapid Desensitization for Needle Phobia.  Psychosomatics 44:253-254, June 2003.

Ferguson JM, Wermuth BM, Taylor CB.  Rapid Desensitization for Needle Phobia.  West J Med. 1976 Feb;124(2):174-6.

Mimura T, Funatsu H, Yamagami S, Usui T, Ono K, Araie M, Amano S.  Vasovagal syncope evoked by needle phobia when inserting a contact lens.  Ophthalmic Physiol Opt. 2005 Mar;25(2):171-3.

Kleiber, Charmaine, Sorenson, Mark, Whiteside, Kathy, Gronstal, B. Ann, Tannous, Raymond. Topical Anesthetics for Intravenous Insertion in Children: A Randomized Equivalency Study. Pediatrics 2002 110: 758-761.  "Children view needle sticks as the worst source of pain and fear in the hospital setting. In an effort to minimize the pain of needle sticks, the use of eutectic mixture of lidocaine and prilocaine (EMLA) has become standard practice in many childrens hospitals."

Leutwyler, Kristin.  Personal Pain: A single gene may account for individual sensitivities.  Scientific American.com.  July 26, 1999.  "People have very different tolerance levels; the same needle may feel like a pinch to one person and an ice pick to the next. Certainly part of how people perceive pain depends on expectations, fears and other psychological influences. But scientists have now gathered more evidence that pain sensitivity has a strong physical basis as well."

Lipton JD, Forstater AT.  Recurrent asystole associated with vasovagal reaction during venipuncture.  J Emerg Med 1993 Nov-Dec;11(6):723-7.  "A patient with a documented history of 2 asystolic episodes associated with venipuncture demonstrates the profound cardioinhibitory effects that vasovagal reactions to blood and injury ('blood-injury phobia') can produce."

Trijsburg RW; Jelicic M; van den Broek WW; Plekker AE; Verheij R; Passchier J.  Exposure and Participant Modeling in a Case of Injection Phobia. Psychother Psychosom, 65(1):57-61 1996. Click here to view the abstract of this article. 

Uhl, G.R., et al. The mu opiate receptor as a candidate gene for pain: polymorphisms, variations in expression, nociception, and opiate responses. Proceedings of the National Academy of Sciences 1999 Jul 6;96(14):7752-7755.  

Valentina Accurso, Mikolaj Winnicki, Abu S.M. Shamsuzzaman, Amy Wenzel, Alan Kim Johnson, and Virend K. Predisposition to Vasovagal Syncope in Subjects With Blood/Injury Phobia. Circulation. 2001; 104: 903-907.

Duff, A J A., Consultant Clinical Child Psychologist, Head of Paediatric Psychology Services, Department of Clinical Psychology, Ashley Wing Extension, St James University Hospital, Leeds LS9 7TF, UK;  Incorporating psychological approaches into routine paediatric venepuncture.  Archives of Disease in Childhood 2003;88:931-937.

 

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You are definitely not alone:

I have received hundreds of messages from fellow sufferers. The most common message is a heartfelt thanks from others who were relieved to discover that they are not alone and that their fear/condition really isn't crazy. In fact, its a defined medical condition!  It would seem this is one of the most misunderstood conditions in all of humanity. It is shocking how many patients have been ridiculed by their families, friends, and even physicians because of this fear.

Click here to read some of the stories by other sufferers and their loved ones.

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Treatments:

I have assembled a handy chart that summarizes the available treatment options, most of which I have tried. I have attempted to give you some idea of what works and what doesn't but you have to understand that individual variability is huge and what works for me might not work for you and so on.

If you are aware of any treatment which I have not listed, please email me at the address at the bottom of this page. I want to have the world's most comprehensive list so that everyone might benefit.

Click here for a summary table of therapies for pain and anxiety control.

Here's what I found that works and what doesn't work:

1. Local anesthetic injections: way too painful. Asking a needle phobe to submit to more injections to reduce the pain of injections is an absurd notion anyway but I included it because its the first suggestion you are likely to encounter.

2. Ethyl Chloride spray, ice, other freeze techniques: completely ineffective.

3. EMLA cream (a local anesthetic cream): very messy, expensive, takes way too long (I wait about 2.5 hours). It only cuts out about 1/3 of the pain for very superficial jambs; cuts out about 10% for deep stuff like inoculations or IV starts. It has the advantage of being completely painless, very portable and can be self-administered. I suspect it works better on children than adults.

4. TAC (a local anesthetic cream containing cocaine): The best of the creams but really hard to get and very expensive.

5. Anti-anxiety drugs like Valium, Nitrous Oxide, etc: completely ineffective for pain (but might help if fear-of-needle-as-object is actually your problem). Of the lot, only Nitrous Oxide helped with anxiety but it doesn't reduce pain at all. During my last Nitrous-only IV cannulation I screamed so loud I'm sure I woke up the dead! My doctors tried powerful sleeping ('knock-out') pills like barbiturates, Halcion, chloral hydrate and others. These didn't sedate me even the slightest but I suspect that even if they did, I'd instantly awaken screaming at the top of my lungs as soon as a needle pierced my skin.

6. Iontophorectic topical anesthesia: This involves applying lidocaine and epi solution to your skin in a patch which is then 'pulled' in deeply using a small electrical current. It REALLY works!  I spent months evaluating several units and at first had a devilishly hard time getting it to work.  Turns out there are a few important things to know and it does take some practice.  My persistence paid off.  It is far more effective than EMLA cream and only takes about 10 minutes (as opposed to EMLAs 60-120 minutes).  Check out the two most popular units at Iomed and Life-Tech's NeedleBuster^tm, a version of their Microphor iontophoresis system. I got mine from Life-Tech. It is very portable (about the size of a cigarette pack) and affordable at a few hundred dollars. The Life-Tech people were great to work with, I highly recommend them.   Update  Aug 2009: it looks as if Life-Tech is not longer promoting their NeedleBuster.  While the MicroPhor would accomplish the same thing, it isn't specifically marketed for needlephobes.   The Needle  Phobia Information Center refers interested patients and health care workers to a compeiting product marketed specifically for needle phobia - its called LidoSite.

7. If these don't work for you, and the injections (or blood draws) are extremely important to your health, try inhalation general anesthesia (use Sevoflurane), but you'll be very lucky to find a doctor who'll do it. And if you can find an insurance company to pay for it you should've bought a lottery ticket 'cause you'd have to be the luckiest sole alive.  Inhalation general anesthesia is the ultimate treatment.  Not very practical, devilishly expensive and difficult to get, it is as sure-fire a solution as you will find.  Try everything else first but know that a final and ultimate solution does exist.  It is the only method I use for any sort of 'serious' procedure.

Oh, I forgot to mention the most often recommended alternative by my business colleagues...a rubber mallet to the head!

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What Motivated Me to Go Public with my Fear

After 3 decades of life, I could no longer postpone dealing with my fear.  Too many problems had caught up with me.

As I am prone to do, I decided to make a project of it.  I would research the fear and devise a solution.   At first I figured it would be pretty easy to understand the fear inside out.  I also thought that medications must surely be available to help solve the obvious pain component of the problem. 

I started by trying to find doctors who would help me.  It took me years to come up with a solution and I went through almost 100 doctors.  At one point I contacted every practicing psychiatrist in our region of the State.  Most did notrespond, quite a few said that they do not get involved in such cases, while a precious few agreed to meet with me to discuss the matter further only to give up a few sessions later. 

 When you have the answer to such a difficult problem, the path you had to take to the answer seems obvious when looking back on it.  The path I chose took so long, cost so much, and was filled with so much grief, anxiety, expense and frustration that I thought "I should write a book".  I was joking of course.  But no one was laughing.

I figured that if anyone else was contemplating going on the journey I have been on, they would benefit enormously from knowing the places I visited along the way...all the wrong turns, the useless advice, and all the dead ends.  The internet seemed the perfect vehicle to tell the story because my path to discovery would not have a wide enough audience to interest a publisher and the Web made the prospect of finding fellow sufferers easy...those who were motivated enough to look into this could find my story right up front rather than at the end of the journey.

So I decided that even if only a few people were seeking this information that I needed to make it available so they could benefit from the story of my admittedly rather long and extreme journey.

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OK people, talk to me...help me to help others:

If you or a loved one is a needle phobe, I'd love to hear your story. Try to include as clear a statement as you can as to what exactly you are afraid of. For some it is pain, others it is the sight of blood, while others are just afraid of the sight of needles. I'd also be interested in what you tried that didn't work, and what you have tried that did work. Please view the summary table I have provided of known treatments and let me know what I have missed.

Important - anonymous contributions wanted: If you have a story about your fear or you have a success story you would like to share with others, or maybe just a word of encouragement, let me know if I have your permission to share your story on this web site so others can benefit.  I will not publish your name or email address (unless you specifically ask and authorize me to).

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Advice for women needle phobes who are pregnant or wish to become pregnant...

     I must get an I'm-scared-because-I'm-pregnant letter every week - sometimes several in a week.  For obvious reasons, I highly encourage needle-phobic women to conquer their fear before they get pregnant.  Once pregnant, you are on a time table that can't be changed.  Conquering (notice I didn't label it 'curing') needle phobia cannot be put on a time table - it took me years.

     Well, if you are pregnant already, you have limited choices.  The good news is that absent any high-risk problems, this is not a medical emergency like being in a car wreck.  You don't absolutely have to have needles.  You can decide to put an increased risk into it and just avoid all needle procedures.  Remember, women had children for thousands of years before needles and modern medicine were invented.  On the other hand, women (and their babies) have been dying in childbirth for thousands of years.  If you have a low-risk pregnancy and everything goes well, you might get away with it.  But you have to purposely decide to increase the risk to you and your child in exchange for not making your morbid fear worse.  Its hard enough already to conquer - you don't need 9 months of help to make it worse.  Please understand this - I am not advocating dispensing with modern medical preventative and pre-natal care, quite the opposite in fact.  I am advocating conquering needle fear FIRST, then going through a thorough program of prenatal care with all the attendant tests, blood work, and spinal anesthesia during labor.  If you are already pregnant, there are no good options, only varying degrees of difficulty.

       Here's a key question: if you opt for needleless pregnancy, and something goes wrong which could have been prevented if you had taken advantage of everything modern medicine can offer you...how will you feel?  How will you cope?  What if your child is deformed or retarded and you could have prevented it?  I know this is a terribly difficult question, but it's one you need to ask yourself.  And I think it goes without saying that for your relationship, your husband's full understanding and support of your decision is vitally important.

       Your big issue is if you need a C-section.  That is your enemy.  And don't expect much encouragement from your doctor - he is in it for safety, not lack of fear.  He will order a huge amount of needle-procedure-driven tests and treatments if needed to diagnose and ensure safety - that's what he's there for.  By denying him needle procedures, he will be limited to fetal heart-rate and ultrasound tests.

       And, there is the issue of pain during delivery.  If you don't mind pain, then going the 'natural' way might work fine.  But if you need serious pain control, there isn't much of an alternative to a spinal.  You could opt for general anesthesia (again, at increased risk to the baby), but they will want to do the general with needles.  You can have inhalation (gas) general, but its really really hard to get arranged because the doctor and the hospital will want an IV line established first (for safety).  You should know that it IS possible to get a completely needle-free full general anesthesia during pregnancy/delivery.  But its hard to arrange and works better for C-sections.  After all, if your labor is 30 hours long are you/they going to want to be unconscious (in a medically induced coma) for 30 hours?  I doubt it.  You could opt for a C-section simply due to the need for needle-free general anesthesia.  This increases risk of course and you won't experience the birth, if that is important to you.  Finally, I doubt insurance will pay for a C-section that isn't medically warranted...so cost is an issue also.  Its possible to get it done, its just really hard and you have to find a VERY sympathetic doctor.

     Meanwhile you could embark on a crash anti-phobia program in hopes of conquering your fear before you need serious needle work.  I really doubt it wil yield under such pressure and diress.  Normally you need a completely stress-free environment in order to start.  My web site gives a run-down on the procedure(s) to undertake such a project.  There are no guarantees and it can take months, even years.   Getting a needle buster and becoming proficient in its technique would be an excellent place to start.  The beauty of this is that I think everything in prenatal care is shallow....mostly IV stuff and blood draws.   This is where the needle buster shines.

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Vicarious Needle Phobia

Don't bother looking it up because you won't find it.  The strangest manifestations of Needle Phobia is one that I call Vicarious Needle Phobia.  Webster defines Vicarious as "performed or suffered by one person as a substitute for another or to the benefit or advantage of another."   I was shocked when I first heard of this but the more I looked, the more I saw of it.  Talk with any phlebotomist or ER nurse and you will hear of instances where they draw blood from a patient then 'boom", the patient's mother or sister or father or boyfriend passes out and hits the floor.

I advise health care workers to have everyone sit down during a patient's blood draw because of the risk of Vicarious NP.  The reason is to prevent the damage that can occur when someone the health care workers isn't watching passes out and hits their head on a table on the way down to the floor. 

 I haven't quite figured out the etiology of Vicarious Needle Phobia - I don't know what causes it but I'd guess the fear is associative in native.  If it is associative then it's not a distinguishable fifth type but rather just an alternative version of one of the major four types already described.  Even more strange is the fact that in at least some of the cases, Vicarious Needle Phobia can take the form of the Vaso Vagal Reflex.  This is very unexpected - how can a protective physiological reflex be initiated in someone else?

With not much to go on, I can still tell you that I am already convinced that Vicarious Needle Phobia isn't a distinct fifth type but rather its merely an alternative manifestation of one of the major four types of Needle Phobia already discussed above.

 April 2007:  Recently, I received the following interesting information on Vicarious Needle Phobia from a reader (reprinted with permission):

I'm both a neuroscientist and a needle phobic, and I thought you might be interested in some new research on vicarious needle experiences.  There are some new studies showing that seeing someone else having a needle stick and having one yourself activate the same brain areas.

Cogn Affect Behav Neurosci. article: Vicarious responses to pain in anterior cingulate cortex: is empathy a multisensory issue?

Nature article: Transcranial magnetic stimulation highlights the sensorimotor side of empathy for pain

So a fainting response from watching someone else's needle procedure is entirely plausible.  For example, I know that I cannot watch scenes from movies involving needles, and I can't look at the figures in the above papers either.  But it would be interesting (from a neuroscience point of view) if there are people who ONLY have vicarious needle phobia and aren't afraid of having needle sticks themselves.  Do you know if such people exist?

To which I responded:

In reference to your question as to whether anyone has vicarious needle phobia but not needle phobia on their own needle procedures, the answer is 'yes'.  I knew of such a lady very well.  She was my secretary for many years.  In fact, she fainted when witnessing needle procedures ONLY on loved ones.  She could watch it on TV, or in the hospital.  But she could not witness needle procedures on her husband or children, especially her children.

When I first encountered vicarious needle phobia, I couldn't understand it.  I could not see how the physiology of vicarious vaso-vagal syncope could work.  I was very familiar with the biochemical pathways of vaso-vagal syncope, but vicarious reactions where so strange, that I considered it a fifth manifestation of Needle Phobia.  After years of examination, I have decided it is just a variant on one of the four major forms, in this case, vaso-vagal needle phobia.

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 Links:

 DirPedia.com - combining a dictionary, an encyclopedia and a web directory
 On-Line Term Life Insurance which doesn't require a blood test.  Listing does not imply endorsement.

 

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Disclaimer: I am not a medical professional and I share this information in the hope that others might benefit from my experience. The information contained in this site is not intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. Nothing contained in the site is intended to be a substitute for medical diagnosis or treatment.