Jan. 2, 2008 -- It's a phobia that filmmakers have loved for years. At a tense moment, someone, usually a man, sees a needle and crumples to the floor.
But it wasn't until 1997 that the mental health community officially recognized needle phobia in the Diagnostic and Statistical Manual of Mental Disorders, thanks largely to an article by physician James Hamilton.
Now, mental health experts estimate that needle phobia, sometimes called belonephobia, may affect up to 10 percent of the population — and it may even be inherited.
While the condition may represent just an occasional inconvenience for some, for others, it can have a dramatic impact on day-to-day life.
"Every time I went to the doctor, it was a shop of horrors," says Keith Lamb, an emergency medical technician in Columbus, Ohio, and long-time needle phobia advocate.
For years, Lamb could not even walk through a dentist's door, due to his needle phobia, which, he says, started with a childhood memory of being separated from his mother to receive a shot. He says he recalls being brought down a long hall, led into a strange room, and told to sit on a tall table.
When Lamb reacted nervously, he says, the doctor intimidated him with the needle.
"If you don't take your shot, we're going to tell your mom, and she is going to whoop you something," Lamb recalls the doctor saying.
While Lamb says his fear of needles continued to plague him in the years following this incident, his phobia truly came to a head when he enrolled in EMT training, and was required to "practice" injections with a partner.
"I can dish it out, but I just can't take it," says Lamb. Although he says the class laughed when he brought up his needle phobia, most health care providers know all too well that needle phobia is no laughing matter.
Needle Phobia Far From Trivial
For many, it's not just the prospect of getting a shot, but sensitivity to the actual pain of the shot itself that's at the root of their phobia.
In order to administer an injection, a health care provider must navigate carefully through tissue, tiny veins and nerves to an injection site. Extra movement can push medication into the wrong layer of tissue, causing weird sensations, or push a needle through the other side of the vein, necessitating a repeat try.
"When we do a puncture, we go into a network of small nerves," says Dr. Sudhir Diwan, director of pain medicine at Weill Medical College of Cornell University in New York. "When someone jumps, there can sometimes be a nerve injury, and that causes more pain."
Ironically, the fastest way to numb an intravenous injection site is with the injection of an anesthetic. While topical gels or cream take 10 to 20 minutes to work, and have to be covered with a plastic dressing, an injection of anesthetic usually takes only 10 seconds to work — and it's cost effective, to boot.
But convincing someone that an injection is a convenient method with "minute" pain, as Diwan puts it, usually isn't the problem.
"Education definitely helps, but perception is entirely different," says Diwan.
"I'm not personally successful at influencing perception," he says. "My son — he faints at the sight of a needle."
A Physical Reaction
In belonephobia, the most prevalent form of needle phobia, the mere sight of a needle triggers a physical domino effect known as a vasovagal reaction: a central nerve flares up, then blood vessels dilate, blood pressure drops, and the person faints.
"It's not something somebody just made up, it's not a weakness in character, it's a reflex," says Lamb, who dreads the needle, but doesn't suffer from a vasovagal reaction.
Fortunately, non-fainting needle phobes like Lamb may not have to wait long for science to find a physical rationale for their fear.
Researchers at Emory University in Atlanta actually mapped feelings associated with dread in the brain, using MRIs. In a paper published last May in the journal Science, the researchers told 34 volunteers how long they would have to wait for a foot shock — between five and 40 seconds — and then, actually shocked them with varying degrees of voltage.
A third of the participants — the extreme dreaders — reported that the shocks were more unpleasant when they had time to anticipate the pain, even if the same voltage was used. MRIs showed different brain activity between self-reported extreme dreaders and non-dreaders.
Fearing Fear Itself
Lamb, who had knee surgery last week, says that his fear of needles would have posed a huge problem had it not been for a relatively new device called a pain patch.
"It's the ultimate conflict. I need the surgery, but I can't stand it," he says. But Lamb says his pain patch device — which uses a weak electric current to usher anesthetic gel into the skin without a needle — allowed him to forego traditional anesthetic injections.
Several such products are on the market — Numby Stuff, NeedleBuster and LidoSite are three examples. Lamb says he paid for his own NeedleBuster, and brought it with him to his knee surgery.
"I used it close to a dozen-and-a-half times in the past week," he notes.
But he says he believes the best way to avoid the inconvenience of needle phobia is for parents to deal with such problems in their children the first time they notice them.
In short, he suggests, don't restrain children, don't chastise them, and praise them after shots.
"You want the first exposures of that child to the medical industry to be the best ones, not the worst ones," Lamb says.