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Nine Ways You Can Reduce the Pain and Fear of Needing a Needle

This is the second installment in a two-part series on what’s working to prevent and address needle fear. To learn more about needle phobia and what health care providers are doing, check out Part I: “A Shot of Courage for Those Who Fear Needles”. Click to view Amy Baxter’s TED talk on Pain, Empathy, and Public Health.

“Fear is the mindkiller. Fear is the little death.” – Frank Herbert, Dune

Amy-Baxter

Amy Baxter

In 1995, a scientific paper was published for the first time evaluating the prevalence of needle fear and its effect on accessing health care. Since then, studies suggest that the fear of needles is rising, afflicting a quarter of adults and two out of three children.

Needle phobia seems to be more likely in people who are sensitive to a light touch and sharp objects, particularly those with the “red head pain” MC1R gene. While most people acquire needle phobia around age four to six, about three to five percent of people have a genetic predisposition to become lightheaded or nauseated or even to faint.

But whether acquired or innate, fear not! Quite literally – here are nine ways to reduce the pain and fear of needing a needle at any age.

1. Pain Management.  When time permits, needle pain can be greatly reduced by using topical pain relief – specifically, topical anesthetic numbing creams and gels — which numb the skin in 20-60 minutes. Fun tip: use Glad® Press-N-Seal rather than the commercial medical covers. It is more comfortable to remove and much less expensive.

2. Let your brain do its thing.  Overwhelm other competing nerves with sensations that aren’t so painful. Studies have found that when someone’s hand is in ice water, they can handle more intense pain everywhere else in the body. This works both through something called gate control (e.g. cool water soothes a burn) as much as brain bandwidth. Vibration and cold have been studied together; when put between the brain and the pain (especially after numbing a shot area directly), they can decrease needle pain up to 80%.

3. Relax the muscles.  Pushing medication into taut muscles makes it hurt more, now and later. Even passively stretched muscles hurt. Rather than bending over and going for a gluteal stick, try lying on your side with the buttocks muscles relaxed. Do the same for thigh shots; sitting up causes the muscles to be active keeping you balanced, so go for a side position.

4. Distract your mind.  Counting and engaging in unrelated tasks can reduce pain by half. At a minimum, count corners, ceiling tiles, or holes in an air grate. Some studies have found that active engagement can be more effective at reducing pain for teens and adults. Drawing on an iPad game or finding items in “I Spy” apps, can work at any age.

5. Distract your senses.  The brain can only process so much at one time. Buy five packs of sugar-free gum, mix the sticks, pick one at random, and try to figure out the flavor. Drink a slug of a cold, sweet beverage. Taste and smell are great senses to counter paying attention to pain.

6. Focus on something you can control.  Whether you’re thinking about the health or life benefits of the shot, concentrate on that. Fertility shots, for example, can have an adorable payoff. Building an idea in your mind and mentally “going there” can help with pain.

7. Create a different sensation.  Pinching your own finger and focusing on that or forcing a cough have both been shown to decrease needle pain. Squeezing your toes, stretching your calf, or making any distant body part more noticeable to your brain will take attention away from the area of pain.

8. Be a scientist.  If you know you have multiple needle events coming up, keep records of what works best and what doesn’t. Being an observer, even of yourself, adds distance that can give you more control. More control = less fear. Less fear = less pain.

9. Speak up!  Let your care team know you don’t like needles, and let them know what you have found what works for you. “You know how some people pass out with needles? Shots and I don’t get along, so let me tell you what works for me. I really appreciate you listening to me; it makes everything go so much better for both of us. What seems to help me is this: “____.” Even if you haven’t ever gotten lightheaded or passed out, reminding care providers of people who have can help establish that you understand that procedural pain is important and you give them credit for appreciating it, too.

Do needles make you nervous? Have you found a strategy that reduces needle anxiety or pain? Post your experiences and tips to the comments section.

You can reach Dr. Amy Baxter at abaxter@mmjlabs.com.

A Shot of Courage for Those Who Fear Needles

This is the first of a two-part series on what’s working to prevent and address needle fear.

Most people don’t enjoy shots.

But for those with needle phobia, the fear of shots can be so severe that they actively avoid medical procedures involving injections, and in extreme cases avoid medical care more generally.

Jamie Elizabeth Rosen

Jamie Elizabeth Rosen

Needle phobia can arise from genetic and environmental factors, including experiencing pain during encounters with needles or seeing others uncomfortable or distressed by needles. Studies show that approximately two out of three children and one in four adults are afraid of needles, and 10 percent of adults have an outright needle phobia, characterized by avoidance behavior and physiological responses, such as increased heart rate or fainting.

The miracle of modern medicine has enabled us to protect ourselves from a range of dangerous or life-threatening diseases. In one recent study, seven to eight percent of adults and children reported avoiding potentially life-saving immunizations as a result of needle fear. Given the growth of vaccine-preventable outbreaks throughout the world (check out this interactive map), this is not only a concern for individual health but also for public health.

Preventing and Addressing Needle Fear

Fortunately, a growing cadre of empathetic health professionals is taking the prevention of needle pain, which can trigger needle fear, to the next level.

“In order to combat pain, vascular access professionals across the country are looking at creative ways to address patient pain and patients’ perception of pain,” said nursing leader and vascular access expert Lorelle Wuerz, MSN, BS, BA, RN, VA-BC. “Offering the patient options before you do any procedure is important.”

Wuerz said that she uses a variety of interventions to combat needle fear and pain in patients, including:

  • Ensuring patients know what to expect;
  • Deep breathing;
  • Guided imagery;
  • Distraction techniques;
  • Topical agents;
  • Warm compresses;
  • Involvement of child life professionals;
  • Pain control devices, such as Buzzy®;
  • Aromatherapy (“Anecdotally, this is something patients find soothing and calming during an uneasy time,” Wuerz said.).

Needle pain prevention extends beyond traditional health care settings. For instance, after discovering that 23 percent of Americans who skipped flu vaccination did so to avoid needles, Target Pharmacy began offering micro-needle flu vaccines. The needles are 90% smaller than those that have traditionally been used and reportedly result in less muscle ache and pain immediately following injection.

“Treating needle pain reduces pain and distress and improves satisfaction with medical care,” wrote pain researcher Anna Taddio in a chapter on needle procedures in the Oxford Textbook of Paediatric Pain. “Other potential benefits include a reduction in the development of needle fear and subsequent health care avoidance behaviour.” 

The 4 Ps of Needle Pain Management

In the Oxford Textbook chapter, Taddio outlined the four domains of interventions that can reduce needle pain for patients, known as the 4 Ps: procedural, pharmacological, psychological, and physical.

Procedural interventions involve bypassing needles altogether through the use of needle-free immunization or non-invasive sampling devices. Pharmacological interventions include local anesthetics, which have been shown to be effective and safe for reducing pain from common needle procedures, and sweet solutions for infants up to 12 months, which have been shown to reduce needle pain behaviors. Psychological interventions include coaching people to cope and providing distractions. Physical interventions – such as upright body positioning, tactile stimulation, and use of cooling agents or ice – can also reduce the perception of needle pain.

Empowering Ourselves

Many people will celebrate the day when shots are replaced with futuristic technology, such as a robotic pill or one of many other innovations currently in development.

In the meantime, what can patients do to help themselves? “A patient should never not speak up,” Wuerz said. “It’s okay to have all of the information before you make a choice.”

Stay tuned for Part II of the series, in which Dr. Amy Baxter, MD – pain researcher, CEO of MMJ Labs, and inventor of Buzzy® Drug Free Pain Relief – will outline how you can protect yourself and your family from needle pain. Dr. Baxter will appear on ABC’s Shark Tank Friday, February 28 at 9:00 pm EST.

How do you respond to needles? What works for you? Have you had a good experience with a health care professional? Post your experiences to the comments section.

Get Your Flu Shot Now to Stay Healthier Later

So you think you’re too busy to get your flu shot? It’s easy to put off, but taking the time to do it sooner rather than later could prevent you from getting sick while helping to protect those you care about – during the holidays and beyond. That’s why the U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), state and local health departments as well as other health agencies are raising visibility around National Influenza Vaccination Week (NIVW), from Dec. 8-14.

Paul DeMiglio

Paul DeMiglio

With the flu season beginning in the fall and not peaking until January-February, it’s certainly not too late to get your influenza shot. In fact, the CDC’s Advisory Committee on Immunization Practices recommends that everyone 6 months of age or older receive it, including:

  • Children
  • Seniors 65 and older
  • Pregnant women
  • American Indians and Alaska Natives
  • Those with underlying health conditions like asthma
  • Those living with conditions including chronic lung disease, heart disease, HIV/AIDS, cancer and diabetes

Although the effectiveness of flu vaccination varies each year, the CDC reports that recent studies demonstrate the evidence-based public health benefits. The Mayo Clinic agrees, calling flu shots your best defense against the flu, enabling “your body to develop the antibodies necessary to ward off influenza viruses.”

“The single best way to protect against the flu is to get vaccinated each year,” said CDC’s Anne Schuchat, M.D., Director, National Center for Immunization and Respiratory Diseases. “Today, flu vaccines are available in more convenient locations than ever. The few minutes it takes to get a flu vaccine can save you from experiencing several unproductive days due to influenza. The most common side effects are mild and short-lasting, especially when compared to symptoms of influenza infection.  Flu vaccine cannot cause flu illness.”

Despite evidence that the influenza vaccine is an effective tool, some still fear that getting their shot might put them at risk for experiencing severe side effects. No more than one or two cases per million people vaccinated acquire Guillain-Barré syndrome, an outcome much lower than the risk of developing severe complications from influenza. From 1976-2006, in fact, estimates show that far more people died from flu-associated deaths in the U.S. (3,000-49,000) than from negative reactions to the vaccines that protect against influenza.

To build awareness and support of NIVW and encourage people to get their shots, the CDC is making a rich variety of online tools and resources available to a wide spectrum of patients, educators and providers, such as:

Partnering with Reckitt Benckiser, Inc., the makers of LYSOL® Brand Products, the CDC is also spotlighting the Ounce of Prevention Campaign, which seeks to empower consumers and professionals with practical tips and information around effective hand hygiene and cleaning habits to prevent infectious diseases like the flu.

Click here to see if the vaccine is available in your area. To find a nearby location to get the vaccine, check out HHS’s “Flu Vaccine Finder” on Flu.gov, enter your ZIP code and share the widget to let your family members, colleagues and friends know where they can go too. HHS also provides a series of informative YouTube videos that cover prevention strategies, share tips for identifying symptoms and provide recommended treatment practices.

You can also make a powerful statement by taking the pledge to get vaccinated for the 2013-14 season, commit to taking a friend with you and in the process spread the word by clicking here. To get the latest updates on flu vaccination efforts, follow the CDC on Twitter (@CDCFlu and @CDCgov) and “like” them on Facebook.

Now tell us if you’ve gotten your flu shot. Where did you go? How long did it take? What ways could providers and health care stakeholders more effectively remind patients to get vaccinated?

Targeted Therapies Open Door to Improved Outcomes and Lower Costs to Treat HCV

As we were reminded on World Hepatitis Day, early detection is critical to turning the tide of this “silent epidemic” that impacts millions. However, strategies to end the deadly effects of viral hepatitis don’t stop there. Personalized treatment is another essential tool that fuels better outcomes for patients with hepatitis C (HCV) while saving money in the long term for the health care system too. 

Paul DeMiglio

Paul DeMiglio

The importance of finding effective therapies for HCV is underscored by the reality that the disease often goes undetected, with an estimated 80 percent of Americans with HCV unaware of their status. Many HCV-positive people show mild to no symptoms, making it more likely for the illness to progress and become more expensive to treat as a result. 

Although safe and effective vaccines are available for hepatitis A and B, none exist for HCV. To help answer this need, Abbott created the fully automated RealTime HCV Genotype II Test – the first FDA-approved genotyping test in the United States for HCV patients – to facilitate targeted diagnosis and treatment that boosts desired outcomes.

This treatment-defining genotyping test empowers physicians to better pinpoint specific strains of HCV, determine which treatment option is best for the patient, and make more informed recommendations about when it should be administered. Available to individuals with chronic HCV, the test is not meant to act as a means to screen the blood prior to diagnosis.

So how does finding the right HCV treatment save money?

Targeted therapies like these are important for diseases like HCV because they reduce the “trial and error” of having to use additional treatments when the initial ones don’t work, saving money and time for patients and providers. Early detection, combined with follow-up care, can prevent patients from developing later stages of hepatitis that can mean more serious long-term conditions that are harder and more expensive to treat.

Treating HCV patients with end-stage liver disease, for example, is 2.5 times higher than treating those with early stage liver disease. Advanced HCV can also escalate to chronic hepatitis infection, a side effect of this being cirrhosis (scarring of the liver and poor liver function) and liver cancer. Treatment for these two conditions (which can include a liver transplant) can cost more than $30,000. Liver cancer treatment can be more than $62,000 for the first year, while the first-year cost of a liver transplant can be more than $267,000.

As more and more patients find themselves unable to afford treatments, HCV is becoming an increasingly larger financial burden on the health care system.

The annual costs of treating HCV in the United States could be up to $9 billion, and over the course of a lifetime the collective cost associated with treatments for chronic HCV is estimated to total $360 billion.

“As we see patients with more advanced liver disease, we see significantly more costs to the system,” says Dr. Stuart Gordon, author of the Henry Ford Study. “The key, therefore, is to treat and cure the infection early to prevent the consequences of more advanced disease and the associated economic burden.”  

Targeted therapies show great promise to improve outcomes while saving time and money by linking patients to the specific treatments they need at earlier points of diagnosis. But what can health systems do to make innovations like the HCV Genotype II Test accessible to more patients and increase the cost-savings benefit on a larger scale?

World Hepatitis Day Spotlights Importance of Early Detection to Improve Prevention and Treatment Strategies

This Sunday, July 28, is World Hepatitis Day, an observance that reminds us that hepatitis (inflammation of the liver) remains largely unknown as a major health threat. Approximately half a billion people worldwide and 4.4 million people in the U.S. live with chronic viral hepatitis, with one million deaths resulting from the disease each year.

Linda Barlow

Linda Barlow

The goal of World Hepatitis Day is to move from awareness to action to address the “silent epidemic” of viral hepatitis – so named because most people don’t experience symptoms when they first become infected, often not until they develop chronic liver disease many years later.

Stakeholders in government and private industry are stepping up to answer the call, supporting early detection and medical intervention as key starting points to effectively address the epidemic.

Earlier this month, Quest Diagnostics announced a partnership with the CDC to improve public health analysis of hepatitis C screening, diagnosis and treatment for the 3.2 million Americans living with it. Under the collaboration, anonymous patient data will be evaluated to identify and track epidemiological trends in hepatitis C virus infection, testing and treatment and determine how those trends differ based on gender, age, geography and clinical management.

“Our collaboration with the CDC underscores the importance of using diagnostic information to derive useful insights enabling effective prevention, detection and management programs for diseases with significant impact on public health,” Jay Wohlgemuth, M.D., senior vice president, science and innovation, Quest Diagnostics, said in a statement.

Early detection was also the focus of a 2012 National Institutes of Health (NIH) study published in Proceedings of the National Academy of Sciences. In the study, researchers concluded that elevated blood levels of a specific enzyme and a specific protein early on in the course of hepatitis C infection were much more likely to develop into advanced fibrosis or cirrhosis. The study found:

  • The long-term course of chronic hepatitis C is determined early in infection.
  • Rapidly progressive disease correlated with persistent and significant elevations of alanine aminotransferase (ALT), an enzyme released when the liver is damaged or diseased.
  • Rapidly progressive disease correlated with persistent and significant elevations of the protein MCP-1 (CCL-2), a chemokine that is critical to the induction of progressive fibrogenesis and ultimately cirrhosis.

Armed with this information, clinicians are expected to make a fairly accurate assessment of which patients are likely to develop advanced disease rapidly. Instead of waiting for a new class of drugs to be approved, these patients are likely to be pressed to start treatment right away – with the goal of treating the virus before it causes cirrhosis of the liver.

Because hepatitis does not result in symptoms until serious liver damage occurs, getting tested is also crucial. In fact, the CDC recommends that everyone born from 1945-65 get a one-time test for hepatitis C because they are five times more likely than American adults in other age categories to be infected and face an increased risk of dying from hepatitis C-related illnesses.

The first FDA-approved hepatitis C genotype test is now available in the U.S. From Abbott, the fully automated Realtime HCV Genotype II test determines the specific type or strain of the HVC virus present in the blood of an HCV-infected individual.

To locate organizations where you can access services including Hepatitis testing, vaccines and treatment, click here. You can also take this 5-minute Hepatitis Risk Assessment to obtain a personalized report from the CDC.

Early awareness and prevention-based practices are crucial to avoiding hepatitis. But what else can be done to ensure access to and availability of reliable and cost-effective screening and diagnostics, in addition to safe and simple treatment regimens for people with the disease?

We hope this post serves as a resource for journalists covering or interested in writing stories about World Hepatitis Day and related issues. Also stay tuned for our follow-up post next week that will address the cost-savings implications of vaccination and early treatment of hepatitis.

Real-Time Health Alerts Join Twitter to Expand Access to Public Health Information

Is Twitter now monitoring your allergies or sleeping patterns?

Linda Barlow

Linda Barlow

In today’s era of real-time information, Twitter has emerged as a leading go-to source for the latest in news, entertainment and more. Now, Twitter is joining Everyday Health, Inc. to create HealthBeat, the first global real-time health alert and news offering. The partnership seeks to provide relevant health information and breaking news to the Twitter community in real time, offering promoted Tweets linking to Everyday Health’s news, expert advice, videos and tools that users can put into action.

HealthBeat will scour the 2 million daily health-related tweets in the U.S. to identify impending outbreaks and other health crises.

“We’ll be looking at the key health terms flaring up every day, and when something is indexing in an abnormal way, we’ll let Twitter know and we’ll supply content about what to do,” said Everyday Health President Michael Keriakos, in an interview published in Ad Age.

For example, Keriakos noted that HealthBeat could have been used to provide vaccination information to residents affected by a whooping cough outbreak in South Central Los Angeles two years ago.

Not only will the partnership provide important information relating to public health, it will also serve as a targeting mechanism for advertisers who are being sought by HealthBeat to promote content around broad health topics like allergies, flu season and insomnia.

While HealthBeat touts itself as the “first global real-time health alert” service, there are other online services – like Google’s flu tracker — that provide similar information on a regional or national level:

  • Launched in 2010, Health & Safety Watch is a Canadian-based web portal and iPhone app that lets users customize the type of alerts they want to see. It also indicates when an advisory or warning is over, for example, when a local water quality issue has been resolved.
  • In the U.S., the Centers for Disease Control and Prevention (CDC) provides alerts about health issues travelers may face when going abroad as well as alerts about disease outbreaks at home.
  • Also in the U.S., a service called HealthMap, developed out of Boston Children’s Hospital, offers an online portal called The Disease Daily, and a mobile app called Outbreaks Near Me.

“The sooner we get a signal of an infectious disease outbreak, the sooner we can devise an appropriate response, and hopefully, the negative impacts can be mitigated,” explained Anna Tomasulo, MA, MPH, HealthMap Program Coordinator, Boston Children’s Hospital.

According to Tomasulo, HealthMap has other tools that help prevent health problems.

“Our Vaccine Finder takes a person’s zip code and provides information on where they can access vaccines nearby,” she says, noting that the project started with flu vaccines but has since been expanded to other vaccines including human papillomavirus (HPV), measles, mumps and rubella (MMR), Varicella and more. “A questionnaire helps users determine what vaccine is most appropriate and provides a list of participating pharmacies within a given radius that provides the vaccine the user needs. Such vaccines help prevent costs associated with illness and potential hospital stays.”

So are HealthBeat, HealthMap and other real-time alert programs providing an important public health service? Are these alerts helpful or will they cause undue concern?

Categories: Access to Care