I work in a Swiss Children’s Hospital. We use lidocaine cream or bandaids with topical anesthetics by a brand called EMLA for basically all our blood draws. They’re cheap, take 20min to work, and I’ve never seen a bad reaction to them so, pretty safe.
Yeah i was wondering about topical lidocaine, too. I've used it for getting tattoos, and it worked really well for the first half hour or so; but I don't know if it penetrates deeply enough to solve your problem.
here's the particular stuff i use. i put it on really thick an hour before my appointment, cover the site with plastic wrap, and don't take it off until it's needle time.
aaaand now i see that you addressed topical lidocaine, but i said this stuff when i'd only read the email version and i hadn't read many of the comments yet. sry!
Thanks for writing this up. So many approaches I never considered. My needle phobia causes me to have Vasovagal syncope, my blood pressure drops and I can blackout. My approach has been to take a Xanax for the anxiety, lie-flat, not look at the needle and drink a whole sugary sports drink. This has been gradually reducing the severity of my response to the needle.
There are a variety of topical lidocaine preparations with various properties that may be worth exploring. Most hospitals and clinics have them available.
Depending on the preparation it can be very superficial numbing or it can penetrate a bit deeper into the subcutaneous nerves and anesthetize at least as well as the iontopheresis with a lot less logistical work.
EMLA is probably the best known mixture but plenty of others exist. It takes about 30 minutes to numb to 1-2mm deep but if applied for 2-3 hours can reach depths of 5-6mm.
In my experience, more or less equal. You might ask some venipuncturists about that. One interesting thing about my aversion is I am also really bad at and did my best to avoid having to perform blood draws or give shots while going through med school.... and, of course, chose a profession that requires very little exposure to blood and guts...
As a tall man with a needle phobia, I've heard many doctors and nurses say it is particularly common in tall men. It could just be more noticeable, though, people don't expect us to be wimps.
Hi: You should get credit towards your anesthesiology internship or senior thesis or something... great work, but, also, a little scary. For someone who seems sensory sensitive, that is a lot of "overcoming." I would be interested in clarification about the definition of what you are experiencing. It makes sense that there is a specific phobia (I guess not to all forms of possible pain, like getting stitches or dental work, not sure) but I am not clear about pain aspect of the needle or other pain sensitivities.
If you are clearly a sensory sensitive individual, as in hearing, seeing, smelling, tasting, motion sickness, and somatic sensations (touch, cold, heat, and pin prick, pain) then, it seems more like an amplification of sensory signals that is going on. Once you have had a few challenges to the most sensitive sensations for you, then the fear kicks in about any further challenges to that.
Generally, sensory sensitive folks are really identifiable by the fact that they smell things before or better than almost everyone around the, they can taste things in water that other folks cannot taste, they may be sensitive to disorganized or overwhelming visual input and also light intensities, can hear things better and sooner, notice motion better, and quite often averse to touch and other skin sensory things, like cold, heat, movement of air (even), and are generally the type of person who would say that their best sleeping environment is in a walk-in closet (more or less). Often they can even notice and be disturbed by just someone opening a door and creating a wisp of moving air, even while sleeping. Apartment living can be next to impossible.
I help people understand this sensitivity as something that would make you the best tribal scout in the old days. It turns out that this sensory sensitivity is created by a process in some folks where all, or most, sensory signals traveling to the brain are amplified by what I call our internal amplifier which has been shown to be our locus coeruleus. It is complicated, but it has been shown to boil down to what kind of distribution of certain norepinephrine receptors and transporters are located in the LC, which varies widely from person to person and is controlled heavily by genes.
Some folks can be particularly sensitive to skin sensations, but not other sensations. Some can be particularly good at noticing smells (including disgusting), or differences in tastes (bothersome water, etc.). They often get questioned by others about such smells, tastes, touch and often end up feeling like they are weird or not normal or even "imagining things."
At any rate, I thought I would let folks know about this new knowledge that is finally being understood better. In my practice of psychiatry for over 10 years, I inquired about sensory sensitivities with all my old and new clients using my own set of questions. I discovered that some useful pre-existing medications for lowering blood pressure (called alpha blockers), clonidine and quanfacine, could have incredibly good effects on blocking or otherwise modifying signalling from the LC, and thus, actually lowering sensitivity by reducing amplification, without sedation.
Especially at bedtime, this can be very useful. Some folks would have you believe that the effect of theses meds is sedation. It is not. At the right dose there is no sedation but the right one for a highly-sensory sensitive person can literally turn down of the amplifier (LC) to a more useful setting for our totally over-stimulated sensory environments. Now, if you want to be a scout for your tribe or the night-monitor, you would not want to turn down the senses. The alpha blockers are similar to what you may know as beta blockers but, in the LC, beta receptors are few.
You can imagine how such a scout-capable gene set would have an evolutionary advantage due to survival capabilities, but not such a great advantage in our overstimulating new world. Hope that makes sense. Again, I love your scientific style and attention to detail. There is a group that is soliciting possible solutions called EveryCare. You might let them know what you have figured out. It is a volunteer scientific group trying to gather as much information from "informal" sources as formal sources.
Thanks. Actually me too. I am not sensory sensitive, but put a needle in my arm... you better have me seat-belted. More than once, passed out. Not so bad with vaccinations, but any bigger needle... um, yikes. Again, really good post and work on your part. Best wishes.
Propanol 40mg after an adrenaline surge. Will cause you to no longer to have that phobia. Its called the MEMREC/Kindt Methods a clinic in Amsterdam specializes in this.
Have you tried EMLA cream (this is different than typical topical lidocaine)? Used all the time for kids prior to IV placement. put a dollop on the skin and cover with a non-absorbent occlusive dressing for 20 minutes or so. You can leave on longer for deeper penetration. Good luck!
What about something like Lidocane to numb the area around the injection site? I have Hemophilia which required me to give myself intravenous infusions every 1-3 days since I was a child, so I understand the intrusiveness of a needle. I still hate when other people need to get a vein for blood or other things.
I used to have an infusion port in my chest and we used something like Lidocane that we called "Emla cream" that numbed the area. It worked because we had to stick a 2" needle straight into my chest and it was really unpleasant and I was very scared for the 2-3 years I did this in my teens.
The Iontophoresis Hack!! That is straight-up cyberpunk medicine. You reverse engineered an FDA cleared device, sourced the chemicals yourself, and somehow didn’t end up on a watchlist. Feels like something out of a Neal Stephenson novel. Honestly, this whole write-up is a wild mix of scientific rigor, deadpan humor, and sheer determination. The medical field should be taking notes. Huge respect for figuring this out and sharing it in a way that’s both ridiculously detailed and actually entertaining.
I can handle shots so it's not quite a needle phobia per say - but I have significant trouble with blood draws.
something about the thought of things that are supposed to be inside the body, being brought outside the body - is profoundly upsetting. I don't even like the word 'vein'. (Piss, shit, jizz, snot, and even vomit are SUPPSOED to come out of the body – so they’re not disturbing. Blood is supposed to stay where it is!)
I can do blood draws if I'm allowed to lay down, legs fully level with the rest of my body. More experienced nurses just laugh at me, then lay me down with my legs level and get the blood draw over with. I’m comfortable being laughed at a bit as long as I’m still allowed to do what I need to do to get the process over with without me passing out.
HOWEVER - The last couple times of I was scheduled for a blood draw...
I got some meth-head tattooed youngish phlebotomist - and when I told her i needed to lay down, she put me on the table but did not put up the leg extension - so while my head and torse were laying down - my legs were still off the table hanging down. Big mistake. This is not actually laying down! i was so frazzled from anxiety I didn't realize this would be bad. She did the draw - and then instead of the normal – “just lay there and rest for a couple minutes [you big baby] until you feel steady” that I get from older nurses - she was just like "ok - you're done, let's go back to the waiting room". Full lizard brain took over at this point and up I went... she ditched me at the receptionist and then down I went face first on the floor.
I somehow woke - realized I was in the way and thought in my stupor "i'm in the middle of the floor, I don't want to get i people's way, that's rude" - stood up, made it to waiting room, passed out face first on the floor again. When the doctors forcibly woke me up several minutes later i realized this caused quite a commotion that I was blissfully unaware of. I was sleeping great!
Same doctor's office but several months later... I once again say i need to lay down. I again get a young phlebotomist - she brings me to the same freaking room - says - lay down, doesn't put out the leg extension has no idea how serious my condition is... so I just yeeted out of there at top speed.
There is a word for this condition. I know it because it’s on my chart. Vasovagal syncope.
I might have all kinds of shit wrong with my blood and we'll never know until this freaking doctor gets old school old lady phlebotomists again.
I actually know the phrase Vasovagal syncope because one time I was at my cardiolists – no blood draw – just the standard “I need to see you once a year in order to give you Lipitor”. But it was around lunch time, I hadn’t had lunch, and the waiting room took an hour – so then I get into the doctors office itself and was left in her office for another half hour without food or precious precious caffeine. While waiting for doctor…. I was looking at the stuff on the walls and on the wall is a very detailed diagram of a heart – and all it’s different veins and quadrants… and I don’t like that v-word and I don’t like thinking about things that are supposed to stay in the body…
But I was holding it together – then the nurse finally came in to take my blood pressure – no food, no caffeine, getting queasy from having to look at heart diagrams… and then they started squeezing my veins – that horrible fucking word – veins….. BP drops to like 40/60, I got white – everyone panics. Much fun. That’s how I got diagnosed the Vasovagal syncope.
I think it’s an old evolutionary response. Back in the day If you had a massive wound with blood pouring out your body – long odds of survival strategy is – drop blood pressure to try not to bleed out. So now, if blood goes out of my body – even tiny needle quantities – down I go. I can handle minor cuts – but something about it coming out of a vein…. UGH. I get queasy just writing that word. Jesus.
I've since learned that if you feel like you're doing to pass out - immediately lay on the floor and put your legs up on a chair. the idea is to get that blood out of your legs and back into your head so you don't pass out.
I wonder if you could rig up a jet injector instead of using needles. Jet injectors fell out of use because they were great at spreading hepatitis B if reused between patients, but if you're the only one using it, it shouldn't be an issue.
There is a more modern (and single use) version of the jet injector called the "j-tip" (I honestly don't know if it requires a prescription to purchase but again, most hospitals have them and it's available through most medical distributors [also I assume it's therefore absurdly expensive]). I'm a pediatric intensivist and my experience is that it's pretty good for kids, though the jet instillation of the lidocaine is a bit shocking to anxious children. Since your problem is limited to needles alone it may be fine.
If you've already tried topical lidocaine and that has failed my horseback guess is that jet injection (whether by older devices or a j-tip) is unlikely to be significantly better. As I mentioned above with less granularly is that not all "topical lidocaine" is the same, it comes in concentrations from 2% to 10% and different suspension creams can affect how well it moves through the skin. Beyond that there are mixtures of lidocaine-prilocaine which are generally considered (and evidenced) to work better than lidocaine alone. EMLA is the most common which is lidocaine 2.5%-prilocaine 2.5% and available as a generic as well. The depth of effect is a time dependent phenomena, various studies can give you a sense of how long each effect lasts.
For what it's worth I've sewn up many impressively deep and complex lacerations with nothing more than topical lidocaine creams or EMLA on small children who even at the best of times are not famous for their chill attitudes towards needles (including one of my own kids, in my kitchen on his eyebrow). It works well as long as it's paired with *a lot* of patience for it to fully take effect.
If you used an absolute ton of it and left it on for a long time it's possible to absorb enough to cause methemoglobinemia or some other toxicities but your writing makes it seem like you're more than capable of finding the relevant pubmed articles and doing the basic math to attenuate that risk to nearly zero.
Wow, that is fascinating, thanks for sharing this. I developed a needle phobia relatively late in life, around 28 or 29 (I'm now in my 60's). I actually have a hard time calling it a phobia, since I don't actively fear needles. I can think back on injections I've received, and it doesn't really bother me. But man, some injections or procedures will cause me extreme 'discomfort', and once I almost passed out while driving about 10 minutes after getting a large horse-needle sized injection. I did actually have some luck with accidental exposure therapy while being treated for prostate cancer. I had a whole bunch of injections, some contrasting dyes injected which required having a large needle in my wrist for about an hour, as well as biopsies and other procedures that you probably won't want to hear about. But whatever benefit I got from that is gone now. If I have to have a big injection now I just let the provider know, and make sure I'm lying down in case I pass out.
Needle phobias are no joke. I absolutely despise them and luckily manage to avoid them... Blood draws are somewhat ok though, it's the actual injection that gets me. Bah.
I know nothing about this, but wonder if beta blockers will make you more likely to faint. So, imagine if the beta blockers have already lowered your heart rate and blood pressure to the point where you’re nearly fainting, and then you have the syncope reaction to the needle on top of that.
I have Grave’s Disease, for which the standard treatment includes propranolol. I have been on 80mg/day propranolol, and on currently on 7.5 mg bisoprolol instead.
I am tempted to say that the anti-anxiety effect isn’t very noticeable, even at the larger doses you get for Grave’s Disease instead of anxiety.
Except … given that I have Grave’s Disease, the effect of beta blockers is so large that I’d probably barely notice if there was an anti-anxiety effect as well. So I don’t know how effective they are for people whose endocrine system isn’t trashed.
I have a needle phobia - fainting + dread, but not panic attacks. Somewhat translated into a generalized medical anxiety. I have fainted at the optometrist and during an x ray. Things that worked for me probably won't work for you, but they might work for someone, so I'll write them up anyway.
"Don't look at it/don't think about it" never worked for me. What has been helpful is minimizing preparation. I used to spend a lot of time planning - picking out a sweater that I could put on quickly when the shot was done, planning exactly when I would go to the pharmacy, picking out a song to listen to, planning what I was going to do immediately afterwards, etc. I thought I was making things go more smoothly, but what I was really doing was getting worked up. I was giving myself a bunch of cues that danger was around the corner, and I responded in kind.
Now, I plan as little as possible. If I need to get a shot, when I have time, I go to the pharmacy and get it done. No making sure all my shit is done for the day, no planning for a convenient time to faint, no planning at all. (Note that it still happens on my initiative. It would be very bad for my wife to suddenly say "let's go get flu shots right now")
As for the actual event, it was never the pain that bothered me, it was the concept of it. I could be completely numb, and watching an injection would still freak me out because it's still violating my skin. What helped in the moment (and this is real caveman shit, embarrassingly so) was to reinterpret the injection as a form of violence.
I love combat sports! I don't love getting punched in the stomach, but it comes with the territory. Violent, painful injuries are something I know how to cope with. You keep your chin down and keep fighting, and after all's said and done you shake hands and say "you got me pretty good back there". Using that framework to understand a needle made things much more manageable.
I work in a Swiss Children’s Hospital. We use lidocaine cream or bandaids with topical anesthetics by a brand called EMLA for basically all our blood draws. They’re cheap, take 20min to work, and I’ve never seen a bad reaction to them so, pretty safe.
Yeah i was wondering about topical lidocaine, too. I've used it for getting tattoos, and it worked really well for the first half hour or so; but I don't know if it penetrates deeply enough to solve your problem.
here's the particular stuff i use. i put it on really thick an hour before my appointment, cover the site with plastic wrap, and don't take it off until it's needle time.
oh lol forgot the link sry https://www.madrabbit.com/products/numbing-cream-with-menthol?nbt=nb%3Aadwords%3Ag%3A21768143401%3A166596388685%3A715355089858&nb_adtype=&nb_kwd=tattoo%20numbing%20cream&nb_ti=kwd-2269263793&nb_mi=&nb_pc=&nb_pi=&nb_ppi=&nb_placement=&nb_li_ms=&nb_lp_ms=&nb_fii=&nb_ap=&nb_mt=b&wm_source=google&wm_medium=ads&wm_ad_id=715355089858&wm_adgroup_id=166596388685&gad_source=1&gclid=CjwKCAiAn9a9BhBtEiwAbKg6flWUrN4YBcvgezRvMBJFu7ckiW5_PGZa-mnSn4dNwjVPXyH_t0oqNBoCqZwQAvD_BwE
aaaand now i see that you addressed topical lidocaine, but i said this stuff when i'd only read the email version and i hadn't read many of the comments yet. sry!
Thanks for writing this up. So many approaches I never considered. My needle phobia causes me to have Vasovagal syncope, my blood pressure drops and I can blackout. My approach has been to take a Xanax for the anxiety, lie-flat, not look at the needle and drink a whole sugary sports drink. This has been gradually reducing the severity of my response to the needle.
There are a variety of topical lidocaine preparations with various properties that may be worth exploring. Most hospitals and clinics have them available.
Depending on the preparation it can be very superficial numbing or it can penetrate a bit deeper into the subcutaneous nerves and anesthetize at least as well as the iontopheresis with a lot less logistical work.
EMLA is probably the best known mixture but plenty of others exist. It takes about 30 minutes to numb to 1-2mm deep but if applied for 2-3 hours can reach depths of 5-6mm.
Good on you for persevering and finding a solution. This will undoubtedly help lots of other women with their own needle phobia.
Does needle phobia mostly or almost entirely affect women but not men?
In my experience, more or less equal. You might ask some venipuncturists about that. One interesting thing about my aversion is I am also really bad at and did my best to avoid having to perform blood draws or give shots while going through med school.... and, of course, chose a profession that requires very little exposure to blood and guts...
As a tall man with a needle phobia, I've heard many doctors and nurses say it is particularly common in tall men. It could just be more noticeable, though, people don't expect us to be wimps.
In my experience talking to lots of nurses who are laughing at my inability to have blood draws - it effects men more than women.
The bawdier nurses usually say that men don't like having things stuck in them, but women are more used to the idea. Connotation obvious.
https://pubmed.ncbi.nlm.nih.gov/31953616/
Hi: You should get credit towards your anesthesiology internship or senior thesis or something... great work, but, also, a little scary. For someone who seems sensory sensitive, that is a lot of "overcoming." I would be interested in clarification about the definition of what you are experiencing. It makes sense that there is a specific phobia (I guess not to all forms of possible pain, like getting stitches or dental work, not sure) but I am not clear about pain aspect of the needle or other pain sensitivities.
If you are clearly a sensory sensitive individual, as in hearing, seeing, smelling, tasting, motion sickness, and somatic sensations (touch, cold, heat, and pin prick, pain) then, it seems more like an amplification of sensory signals that is going on. Once you have had a few challenges to the most sensitive sensations for you, then the fear kicks in about any further challenges to that.
Generally, sensory sensitive folks are really identifiable by the fact that they smell things before or better than almost everyone around the, they can taste things in water that other folks cannot taste, they may be sensitive to disorganized or overwhelming visual input and also light intensities, can hear things better and sooner, notice motion better, and quite often averse to touch and other skin sensory things, like cold, heat, movement of air (even), and are generally the type of person who would say that their best sleeping environment is in a walk-in closet (more or less). Often they can even notice and be disturbed by just someone opening a door and creating a wisp of moving air, even while sleeping. Apartment living can be next to impossible.
I help people understand this sensitivity as something that would make you the best tribal scout in the old days. It turns out that this sensory sensitivity is created by a process in some folks where all, or most, sensory signals traveling to the brain are amplified by what I call our internal amplifier which has been shown to be our locus coeruleus. It is complicated, but it has been shown to boil down to what kind of distribution of certain norepinephrine receptors and transporters are located in the LC, which varies widely from person to person and is controlled heavily by genes.
Some folks can be particularly sensitive to skin sensations, but not other sensations. Some can be particularly good at noticing smells (including disgusting), or differences in tastes (bothersome water, etc.). They often get questioned by others about such smells, tastes, touch and often end up feeling like they are weird or not normal or even "imagining things."
At any rate, I thought I would let folks know about this new knowledge that is finally being understood better. In my practice of psychiatry for over 10 years, I inquired about sensory sensitivities with all my old and new clients using my own set of questions. I discovered that some useful pre-existing medications for lowering blood pressure (called alpha blockers), clonidine and quanfacine, could have incredibly good effects on blocking or otherwise modifying signalling from the LC, and thus, actually lowering sensitivity by reducing amplification, without sedation.
Especially at bedtime, this can be very useful. Some folks would have you believe that the effect of theses meds is sedation. It is not. At the right dose there is no sedation but the right one for a highly-sensory sensitive person can literally turn down of the amplifier (LC) to a more useful setting for our totally over-stimulated sensory environments. Now, if you want to be a scout for your tribe or the night-monitor, you would not want to turn down the senses. The alpha blockers are similar to what you may know as beta blockers but, in the LC, beta receptors are few.
You can imagine how such a scout-capable gene set would have an evolutionary advantage due to survival capabilities, but not such a great advantage in our overstimulating new world. Hope that makes sense. Again, I love your scientific style and attention to detail. There is a group that is soliciting possible solutions called EveryCare. You might let them know what you have figured out. It is a volunteer scientific group trying to gather as much information from "informal" sources as formal sources.
im not particularly sensorily sensitive, i just have a genetic needle phobia
Thanks. Actually me too. I am not sensory sensitive, but put a needle in my arm... you better have me seat-belted. More than once, passed out. Not so bad with vaccinations, but any bigger needle... um, yikes. Again, really good post and work on your part. Best wishes.
Propanol 40mg after an adrenaline surge. Will cause you to no longer to have that phobia. Its called the MEMREC/Kindt Methods a clinic in Amsterdam specializes in this.
oh yeah! I have tried propanolol, I totally forgot. Let me edit that in there
its rly useful for physical repsonse during.
but i mean specifically taking it afterwards. your brain reconsoldates the memory without the fear response. https://youtu.be/Ib36Yw1tQlw?si=GGWJ5hKPuzpqOdNr
so like experiencing fear stimulus, taking propanolol afterwards, sleeping, next day no phobia
Have you tried EMLA cream (this is different than typical topical lidocaine)? Used all the time for kids prior to IV placement. put a dollop on the skin and cover with a non-absorbent occlusive dressing for 20 minutes or so. You can leave on longer for deeper penetration. Good luck!
What about something like Lidocane to numb the area around the injection site? I have Hemophilia which required me to give myself intravenous infusions every 1-3 days since I was a child, so I understand the intrusiveness of a needle. I still hate when other people need to get a vein for blood or other things.
I used to have an infusion port in my chest and we used something like Lidocane that we called "Emla cream" that numbed the area. It worked because we had to stick a 2" needle straight into my chest and it was really unpleasant and I was very scared for the 2-3 years I did this in my teens.
I forgot to add in topical lidocaine because it is so ineffective. but most of the post is discussing other ways of getting lidocaine in there
Ya the topical lidocaine stuff didn't dull the sensation of having something inside of my chest. Just the initial jab.
The Iontophoresis Hack!! That is straight-up cyberpunk medicine. You reverse engineered an FDA cleared device, sourced the chemicals yourself, and somehow didn’t end up on a watchlist. Feels like something out of a Neal Stephenson novel. Honestly, this whole write-up is a wild mix of scientific rigor, deadpan humor, and sheer determination. The medical field should be taking notes. Huge respect for figuring this out and sharing it in a way that’s both ridiculously detailed and actually entertaining.
I can handle shots so it's not quite a needle phobia per say - but I have significant trouble with blood draws.
something about the thought of things that are supposed to be inside the body, being brought outside the body - is profoundly upsetting. I don't even like the word 'vein'. (Piss, shit, jizz, snot, and even vomit are SUPPSOED to come out of the body – so they’re not disturbing. Blood is supposed to stay where it is!)
I can do blood draws if I'm allowed to lay down, legs fully level with the rest of my body. More experienced nurses just laugh at me, then lay me down with my legs level and get the blood draw over with. I’m comfortable being laughed at a bit as long as I’m still allowed to do what I need to do to get the process over with without me passing out.
HOWEVER - The last couple times of I was scheduled for a blood draw...
I got some meth-head tattooed youngish phlebotomist - and when I told her i needed to lay down, she put me on the table but did not put up the leg extension - so while my head and torse were laying down - my legs were still off the table hanging down. Big mistake. This is not actually laying down! i was so frazzled from anxiety I didn't realize this would be bad. She did the draw - and then instead of the normal – “just lay there and rest for a couple minutes [you big baby] until you feel steady” that I get from older nurses - she was just like "ok - you're done, let's go back to the waiting room". Full lizard brain took over at this point and up I went... she ditched me at the receptionist and then down I went face first on the floor.
I somehow woke - realized I was in the way and thought in my stupor "i'm in the middle of the floor, I don't want to get i people's way, that's rude" - stood up, made it to waiting room, passed out face first on the floor again. When the doctors forcibly woke me up several minutes later i realized this caused quite a commotion that I was blissfully unaware of. I was sleeping great!
Same doctor's office but several months later... I once again say i need to lay down. I again get a young phlebotomist - she brings me to the same freaking room - says - lay down, doesn't put out the leg extension has no idea how serious my condition is... so I just yeeted out of there at top speed.
There is a word for this condition. I know it because it’s on my chart. Vasovagal syncope.
I might have all kinds of shit wrong with my blood and we'll never know until this freaking doctor gets old school old lady phlebotomists again.
I actually know the phrase Vasovagal syncope because one time I was at my cardiolists – no blood draw – just the standard “I need to see you once a year in order to give you Lipitor”. But it was around lunch time, I hadn’t had lunch, and the waiting room took an hour – so then I get into the doctors office itself and was left in her office for another half hour without food or precious precious caffeine. While waiting for doctor…. I was looking at the stuff on the walls and on the wall is a very detailed diagram of a heart – and all it’s different veins and quadrants… and I don’t like that v-word and I don’t like thinking about things that are supposed to stay in the body…
But I was holding it together – then the nurse finally came in to take my blood pressure – no food, no caffeine, getting queasy from having to look at heart diagrams… and then they started squeezing my veins – that horrible fucking word – veins….. BP drops to like 40/60, I got white – everyone panics. Much fun. That’s how I got diagnosed the Vasovagal syncope.
I think it’s an old evolutionary response. Back in the day If you had a massive wound with blood pouring out your body – long odds of survival strategy is – drop blood pressure to try not to bleed out. So now, if blood goes out of my body – even tiny needle quantities – down I go. I can handle minor cuts – but something about it coming out of a vein…. UGH. I get queasy just writing that word. Jesus.
I've since learned that if you feel like you're doing to pass out - immediately lay on the floor and put your legs up on a chair. the idea is to get that blood out of your legs and back into your head so you don't pass out.
I sympathize with you. You are not alone. 😊
I wonder if you could rig up a jet injector instead of using needles. Jet injectors fell out of use because they were great at spreading hepatitis B if reused between patients, but if you're the only one using it, it shouldn't be an issue.
See: https://en.wikipedia.org/wiki/Jet_injector
Oh shit I didn't know about this! This seems way better than iontophoresis if it works. I'll see if I can get my hands on one
There is a more modern (and single use) version of the jet injector called the "j-tip" (I honestly don't know if it requires a prescription to purchase but again, most hospitals have them and it's available through most medical distributors [also I assume it's therefore absurdly expensive]). I'm a pediatric intensivist and my experience is that it's pretty good for kids, though the jet instillation of the lidocaine is a bit shocking to anxious children. Since your problem is limited to needles alone it may be fine.
If you've already tried topical lidocaine and that has failed my horseback guess is that jet injection (whether by older devices or a j-tip) is unlikely to be significantly better. As I mentioned above with less granularly is that not all "topical lidocaine" is the same, it comes in concentrations from 2% to 10% and different suspension creams can affect how well it moves through the skin. Beyond that there are mixtures of lidocaine-prilocaine which are generally considered (and evidenced) to work better than lidocaine alone. EMLA is the most common which is lidocaine 2.5%-prilocaine 2.5% and available as a generic as well. The depth of effect is a time dependent phenomena, various studies can give you a sense of how long each effect lasts.
For what it's worth I've sewn up many impressively deep and complex lacerations with nothing more than topical lidocaine creams or EMLA on small children who even at the best of times are not famous for their chill attitudes towards needles (including one of my own kids, in my kitchen on his eyebrow). It works well as long as it's paired with *a lot* of patience for it to fully take effect.
If you used an absolute ton of it and left it on for a long time it's possible to absorb enough to cause methemoglobinemia or some other toxicities but your writing makes it seem like you're more than capable of finding the relevant pubmed articles and doing the basic math to attenuate that risk to nearly zero.
Wow, that is fascinating, thanks for sharing this. I developed a needle phobia relatively late in life, around 28 or 29 (I'm now in my 60's). I actually have a hard time calling it a phobia, since I don't actively fear needles. I can think back on injections I've received, and it doesn't really bother me. But man, some injections or procedures will cause me extreme 'discomfort', and once I almost passed out while driving about 10 minutes after getting a large horse-needle sized injection. I did actually have some luck with accidental exposure therapy while being treated for prostate cancer. I had a whole bunch of injections, some contrasting dyes injected which required having a large needle in my wrist for about an hour, as well as biopsies and other procedures that you probably won't want to hear about. But whatever benefit I got from that is gone now. If I have to have a big injection now I just let the provider know, and make sure I'm lying down in case I pass out.
Needle phobias are no joke. I absolutely despise them and luckily manage to avoid them... Blood draws are somewhat ok though, it's the actual injection that gets me. Bah.
I know nothing about this, but wonder if beta blockers will make you more likely to faint. So, imagine if the beta blockers have already lowered your heart rate and blood pressure to the point where you’re nearly fainting, and then you have the syncope reaction to the needle on top of that.
I have Grave’s Disease, for which the standard treatment includes propranolol. I have been on 80mg/day propranolol, and on currently on 7.5 mg bisoprolol instead.
I am tempted to say that the anti-anxiety effect isn’t very noticeable, even at the larger doses you get for Grave’s Disease instead of anxiety.
Except … given that I have Grave’s Disease, the effect of beta blockers is so large that I’d probably barely notice if there was an anti-anxiety effect as well. So I don’t know how effective they are for people whose endocrine system isn’t trashed.
I have a needle phobia - fainting + dread, but not panic attacks. Somewhat translated into a generalized medical anxiety. I have fainted at the optometrist and during an x ray. Things that worked for me probably won't work for you, but they might work for someone, so I'll write them up anyway.
"Don't look at it/don't think about it" never worked for me. What has been helpful is minimizing preparation. I used to spend a lot of time planning - picking out a sweater that I could put on quickly when the shot was done, planning exactly when I would go to the pharmacy, picking out a song to listen to, planning what I was going to do immediately afterwards, etc. I thought I was making things go more smoothly, but what I was really doing was getting worked up. I was giving myself a bunch of cues that danger was around the corner, and I responded in kind.
Now, I plan as little as possible. If I need to get a shot, when I have time, I go to the pharmacy and get it done. No making sure all my shit is done for the day, no planning for a convenient time to faint, no planning at all. (Note that it still happens on my initiative. It would be very bad for my wife to suddenly say "let's go get flu shots right now")
As for the actual event, it was never the pain that bothered me, it was the concept of it. I could be completely numb, and watching an injection would still freak me out because it's still violating my skin. What helped in the moment (and this is real caveman shit, embarrassingly so) was to reinterpret the injection as a form of violence.
I love combat sports! I don't love getting punched in the stomach, but it comes with the territory. Violent, painful injuries are something I know how to cope with. You keep your chin down and keep fighting, and after all's said and done you shake hands and say "you got me pretty good back there". Using that framework to understand a needle made things much more manageable.
Somewhat related: https://x.com/PrinceVogel/status/1293325169797341185