Needles are one of the most common and essential tools in the medical field. Allowing substances to be injected directly into the bloodstream for easier access, they’ve revolutionized the practice of medicine. The needle has had many improvements and enhancements over the centuries, but despite how perfect needles seem, they have one fatal flaw: They’re terrifying, and they hurt.
Trypanophobia is the intense fear of needles. Many of us feel nervous and scared anticipating the pain of an injection. For some, a fear of needles makes a visit to the doctor’s office unpleasant, but others avoid all interactions with medicine to avoid an injection. A complete aversion to needles can be dangerous. It can prevent patients from receiving necessary medication, and unvaccinated individuals put themselves and any unvaccinated peers at risk of extremely harmful yet preventable diseases. Children, who are especially vulnerable to illness, are more likely to have the fear, as two in three children in the U.S. are afraid of needles.
To make matters worse for trypanophobes, the patient has to be relaxed in order for an injection to go smoothly. A typical fear response is tensing up one’s muscles. When our muscles tense up, they become firmer and stronger. This makes puncturing them more difficult, as the muscle tissue is harder to penetrate. This makes the procedure more difficult for the physician, and more painful for the patient.
Some people have developed strategies to reduce anxieties and fears surrounding needles and injections. One of the most commonly referenced suggestions being, “Just don’t look.” While there is no medical or biological evidence for a cure for trypanophobia, some say that looking away from the needle will make an injection hurt less. But is this actually true?
In a study conducted by researchers in Toronto, many of those who reported a preference for looking were actually more scared of the needle than those who were told to look. But why would someone prefer to look at the needle? For some, a fear of the unknown trumps any discomfort around needles. Watching the injection may put a patient at ease because they can anticipate the event.
CARD: The pediatrician’s magic trick
Every U.S. state and territory has a set of required vaccines that students must receive in order to maintain the health and safety of their school community. All Americans that have attended school have been exposed to needles and injections since early childhood.
In order to make vaccine delivery easier for children by reducing fear-related responses to needles, the CARD system was developed. CARD stands for comfort, ask, relax, and distract and is a strategy that many pediatricians and childcare providers use to make anxiety-inducing procedures happen more smoothly. CARD is in favor of not only looking away from the needle but distracting the brain entirely to prevent fear or fear-induced responses. Familiarity with and comfort during the procedure may help children to understand the importance of the procedure and their contribution to community health.
The CARD system shows that distraction from the pain helps to prevent patients from overthinking or thinking about the injection at all. Those who are afraid of needles may prefer to look away so that their fears of anticipating the pain are reduced. Some tryphanophobes panic at the mere sight of needles. In this case, looking away from or distracting oneself from the needle is extremely effective at reducing anxieties and fears.
The magician’s secret? Informed consent
The CARD system is a model for introducing informed consent to young patients. The strategy works by having the child’s provider explain the procedure to them in a clear and comforting manner, giving them complete control over whether or not the injection occurs. Though children are usually injected no matter how big of a tantrum they throw, CARD gives children the ability to understand why they are seeing their doctors and the purpose of the procedure.
Comforting a patient involves making them feel safe and in control of their environment, as well as validated in their feelings. Physicians are normally required to do this with adult patients, as all patients have a right to informed consent. With this right, patients are required to know and understand the procedures they are expected to endure before they participate. For children, all of the important information is usually discussed with parents, and children are told the bare minimum. A child may know that they’re going to see their dentist for a cavity, for example, but not understand why they need to be numbed with an injection in their gums.
In order to comply with informed consent laws and to be sure a patient understands their treatment plan, it is important that a physician asks the patient questions during a procedure. Though physicians are required to inform patients because of informed consent, many fail to explain using plain, everyday language. Medical terminology often clouds a patient’s understanding, which could contribute to fears around certain procedures. Patients learn about procedures by asking their doctor questions. Children may not be able to understand the details of a procedure, but encouraging questions may improve their basic understanding. Physicians can also ask unrelated and personal questions to further comfort children.
In the end, it’s up to the patient to decide whether or not watching the needle will put them at ease. Looking away can be effective in reducing fear, but unfortunately will not trick your brain into thinking there is nothing there.
