Needlephobia

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Many of our patients suffer from Needlephobia's correct name is "Belonephobia". Pain must be the main cause! so how do we ease the pain?

I wished to apply a topical anaesthetic preparation to aviod the pain of the needle before injecting an anaesthetic, I decide that I would try Ametop Gel.

At the local chemist I was told I could only have 1 tube as it comes under P so I could not order a box for future use, why is it restricted?

I have my L/A cert so I must be competent to know when to use it.

How can we change the list so as Podiatrist use it?

Joseph

 

Hi Joseph, I know its old fashioned but have you ever tried Ethyl Chloride. Its pretty pungent, not to mention explosive, but I have occasionally used it with good effect before I give a digital block. The other alternative is iontophoresis with 'numby stuff' (I kid you not!) try a search on the web.

Regards,

Martin

 

hi joseph

how about Xylocaine spray and you can order from normal podiatric suppliers

jude x

 

Won't work - it needs a mucus membrane to penetrate (ie in the mouth) .... I can never understand why podiatric suppliers even sell it.

 

I have tried expensive freeze sprays but they never seem to work, maybe the temperture in the clinic is a factor as ti why they evaporate to quickly.

 

I use ethyl chloride spray for all injections in my clinic. It works better being held about 12-18" away from the skin until the skin just starts to turn white. Once the skin turns white, this is the time to stick the needle through the skin since the patients won't feel the needle stick. In fact, for my patients with plantar fasciitis, the needle stick is done directly plantarly through the heel with no discomfort, other than a cold sensation on the heel while the needle stick is being performed. The cortisone and anesthetic being infiltrated into the soft tissues will still will cause varying levels of pain. However, with this technique the needle stick causes no pain. Never had a thermal injury to the skin using this tecnnique probably over 5,000 times in my career.

 

Possible reason for needle-phobia. In my 2nd (mini) job as a practice i was taking blood from a mum whose 5 year old daughter was standing in the corner looking extremely nervous and worried. The mum said that her dad had told her that when the nurse stuck the needle in her mum would pop!!! Daft dad - she could have been scarred for life!

 

Ethyl Chloride gets my vote.

As CP has correctly stated, other preparations only work on mucous membrane.

Regards,
davidh

 

Emla patchs work well. Down side need to be applies 15 min pre needle

 

We have a research paper in press (corrected proof) at the moment with 'The Foot' that showed a simple ice cube dramatically reduces the effect of the pain associated with the needle-stick. Although our study only evaluated this technique on the hallux, it would likely work elsewhere. Unfortunately there was no significant effect on infiltration pain, but most participants (80%) indicated they preferred the ice as opposed to no ice.

Summary below.

Karl Landorf
La Trobe University

SUMMARY
Background: Digital nerve blocks are widely used prior to minor surgery to the digits but the injections are associated with some degree of unwanted pain and anxiety. Methods to reduce the pain associated with injection, such as cryotherapy, are therefore worthwhile. However, cryotherapy (e.g. ice) applied prior to digital injections has received little scientific evaluation.
Objective: This study aimed to assess whether there was any change in pain associated with an injection into the hallux, if the site of injection was first refrigerated using ice.
Method: Twenty participants each received two injections of lignocaine into the hallux (one each on the medial and lateral sides) as a standard digital nerve block. Prior to each injection, participants were randomised to receive either no ice or a six-minute application of ice over the injection site. The primary outcomes were needle-stick pain and infiltration pain measured on a visual analogue pain scale.
Results: The application of ice significantly reduced needle-stick pain, with the median scores for the no-ice and ice injections being 57mm and 16mm respectively (P<0.001). With respect to infiltration pain, however, there was no significant difference in the median scores (49mm and 47mm respectively, P=0.204). Nevertheless, 16 out of 20 participants preferred ice prior to the injection. Only four indicated no preference and none indicated a preference for no ice.
Conclusion: Icing the digit prior to injection is an effective and inexpensive method to reduce the discomfort of a local anaesthetic injection.

KEY WORDS: Ice, Injection, Local Anaesthetic, Digit, Pain

 

Good one Karl! And, if many patients don't need injections that day then the ice can be used as the cooling agent in a motorized blender full of rum and other syrupy liquid ingredients at the end of the day of a busy clinic to aid in the amelioration of the stress of private practice!

In all seriousness, ethyl chloride spray is not too expensive per use and I would imagine is much, much faster than an ice cube at freezing the skin to the point of topical anesthesia. Time is money in a busy podiatric practice. But if you are looking for saving on the costs of practice, rather than saving time for the patient and busy practicing podiatrist, then an ice cube will probably do the job quite nicely.

 

Very interesting study, I may try this method one day.

 

Just to clarify, from the point of view of one who suffers from a needle phobia, pain is actually a very small part of it for me.

I am significantly better now than i was 10 years ago but even then the phobia was more about the nature of injections than the actual pain. I have always been able to cope with having a damn great needle shoved in my arm for withdrawing blood, even managed to give blood a few times. The flu jab on the other hand had me passed out on the floor of the nurses room before she even touched me with it (oh the humiliation, it was a surgery i was working in at the time!).

Likewise i can now cope with intravenous injection but not subcutaneous.

I've had many rather large fillings at the dentist with no injection. Now that hurts a **** of a lot more than the needle.

So far as i am concerned i would be no happier having a digital block if i was numb from the waist down!

Don't know if this is typical!

Regards to all
Robert

 

Has anyone tried a tens nerve unit to block the pain when giving L/A?

 

Tens for needle pain.

Hi Joseph,

I have never used Tens, personally I think developing a good technique is the best thing you can do for your Patient. A decisive and confident approach is vital. If you cringe for your Patient then they very easily 'catch your discomfort'. Perform the injection without unnecessary delay and use an analgesic agent warmed to blood - heat. This is easy if you use dental cartridges. You can, I believe, get cartridge heaters, but I just keep them in my top tunic pocket for half an hour. Use the finest needle you can use for a particular site. I routinely use 30g silicone coated needles for digital blocks, even halluces. Also, I obscure what I'm doing, with my body position etc, some people are distressed when they watch the injection, but can cope fine if they just feel the scratch.

Regards,

Martin

 

I have suffered from needlephobia since childhood and the misconception I come up against every time the subject comes up is that I am afraid of the pain of an injection. I am not afraid of the pain (I have all my dental fillings without anaesthetic, so could hardly be called squeamish) I am PHOBIC of medical injections or blood tests.

Needlephobia seems to be widely misunderstood, and this hampers progression towards a solution. The concept of allowing someone to stick a piece of metal into my delicate veins and either pump something in or suck something out is what troubles me. So please move away from the pain issue and try to work out alternative methods, or at least try to listen to what needlephobics are trying to communicate to you.

To me, suggesting a pain killer to a needlephobic is equivalent to suggesting to an arachnaphobe that a pain suppressant rubbed into their skin will make them happy to have a spider running all over their face.

Thanks for listening.

 

I'm interested that the bulk of modalities discussed tend to deal with the needle entry but don''t address the other aspect of injection pain that occurs when you deposit the LA. Has anyone used the "wand" that has become popular with dentists to control the velocity of the solution to make it more comfortable for the patient? I remember discussing the idea of simply using a 27 or 30g needle to make skin entry easier, but the trouble we encountered is that the anaesthetic comes out faster and is actually less comfortable, which no amount of skin freezing will alleviate.

 

I refer you to my earlier post and the one from Needlephobic. The pain is utterly irrelevant to somebody with a true belonephobia. It might help with people who are afraid of pain but that's a different problem!

This is a very accurate description!

Regards
Robert