Overcoming the Fear of Needles

Overcoming the Fear of Needles
By Peter Laird, MD

The fear of needles, large dialysis needles, is a very commonly cited reason for seeking alternative treatments to hemodialysis with peritoneal dialysis and renal transplantation. I have always hated needles despite my use of needles on a near daily basis in my internal medicine practice, the difference being I was giving not receiving the use of the needles. Despite my calm assurances to my patients with the needles I used on them, I would run away from my annual TB test which has a tiny little needle injected in the very surface layers of the skin. While in the Army, I was able to avoid the whole panel of injections needed to be deployed on an emergency basis should they have called. I quite simply hate needles and always have, yet today, not only do I use needles to stay alive, I use very LARGE needles that have an internal lumen large enough to look inside of them.

While all patients starting dialysis express a dislike of needles, there are a small percentage that have an actual physical reaction to needle insertion with heart racing, cold, clammy skin and some people actually pass out. Scientists have identified up to 10% of the population that have either an acquired reaction to needles and/or a genetic predisposition to the fear of needles. For patients that must utilize needles for dialysis, this becomes a significant problem not only for the patient, but for the staff treating them.

A common reaction by patients with severe needle phobias is to keep their catheters and avoid fistula or graft placement, yet this exposes them to higher risks of infection and death. Behavioral therapy techniques are effective in overcoming these fears often through forms of desensitization. Home Dialysis Central has an excellent review on the fear of needles and techniques that work at the bedside for patients that all should review if this reaction is preventing you from obtaining the treatment options such as a fistula which is known to improve survival on dialysis: Dialysis Needle Fear: Easing the Sting.

Fortunately, for most patients, it is simply the fear of the pain of the needles themselves that is the issue. Many patients ask for local pain shots before cannulation, but this can cause build up of scar tissue and is best avoided if possible. A popular form of local anesthesia is topical creams such as EMLA ( Eutetic Mixture of Local Anesthetic) which contains two topical anesthetics, Lidocaine and Prilocaine. Many patients use this product effectively and are able to learn to self cannulate once the pain is controlled. Many patients simply become tolerant to the pain which lasts only momentarily and is accepted as simply a minor inconvenience.

The most important issue is to not let your fear of needles become a reason for accepting less than optimal renal care. If you are unable to overcome the fear of needles, peritoneal dialysis and renal transplant may help prevent some of the complications associated with long standing catheter use. Ask your nephrologist and nursing staff how to overcome this very common complication of hemodialysis treatment, your fear can be turned away in most cases.