How one needle phobic managed the COVID vaccine

By developing a routine, this writer overcame a long-held but common fear of needles, which the CDC estimated could prevent around seven percent of the population from receiving the coronavirus vaccine

Laura Dachenbach
Syringes are prepared at a COVID-19 vaccination site.

When I walked up to get my COVID-19 vaccine, I told the white-jacketed woman sitting behind the table that I had not had any vaccines since I was a child. No flu shots. No updates. I told her the reason was because I had a history of fainting with needles.

“You will not faint today,” she said. “Not today.”

I wanted to believe her because I didn’t want to pass out in front of hundreds of people at a mass vaccination event, but mostly because I knew I couldn’t continue to avoid needles for the rest of my life without experiencing potentially dire consequences.

I have never liked needles, but my true needle phobia didn’t set in until college. Following a diagnostic blood draw at the health center, I returned to the front desk to retrieve my student ID and collapsed. From that episode onward, every needle procedure has been accompanied by acute anxiety, a racing pulse, clammy skin, ringing ears and fainting or near fainting. 

“I think you need therapy,” a surgical nurse said as I described my condition and asked about options for placing an IV. I narrowed my eyes at her, not understanding why the only available form of topical pain relief for a needle procedure was a different needle procedure. She, in turn, did not understand why I protested a tiny subcutaneous injection until the adjacent monitor lit up like a scoreboard with my spiking vitals.

I challenged another nurse encouraging me to update my tetanus vaccine, asking what she could offer in terms of pain or anxiety relief. “Maybe it won’t be as bad as you think,” she countered. (Hey, I could say the same about tetanus.) Our negotiation resulted in a stalemate and no vaccine.

While fear of needles is common, about seven percent of people find the fear so disabling that they avoid vaccines altogether, according to the Centers for Disease Control and Prevention. The American Psychiatric Association's Diagnostics and Statistical Manual of Mental Health Disorders (DSM-5) has listed needle phobia (trypanophobia) as a condition for almost 30 years. 

The phobia may be partially genetic, with clusters appearing in families. As a selective evolutionary trait, fear of skin puncture once probably prevented a great number of deaths from infected wounds. But needle phobia is also a learned trait, with patients taking the emotional experience from one needle procedure to another. For some, hypersensitivity to pain or needle pain also seems to be a factor. But despite the legitimacy and prevalence of needle phobia, there are few resources to help those afflicted.

In my quest for understanding, I came across a sobering description of a condition the author called “end-stage needle phobia,” in which patients refuse life-saving medical care that involves needles. Yes, when given the choice between a needle procedure or death, an alarming number of people will choose death.

I was reading a description of my future self. 

But COVID-19 is not a solo phenomenon, and a decision to skip vaccination could affect the health of others beyond myself. I wanted to be part of the solution. I wanted the vaccine.

My work-related vaccine eligibility arrived unexpectedly, giving me just days to plan a vaccination survival strategy. I felt fairly certain that my needle phobia was not a classical phobia stemming from trauma, but was rather a conditioned response to the needle sensation itself, like Pavlov’s dogs, which learned to salivate in response to a ringing bell when the sound was associated with food. Could I manage to successfully separate sensation and response?

A few days before my appointment, I experimented with a few topical anesthetic products, both patches and creams, and tested my skin sensitivity with a toothpick, noting how long it took each to take effect and how long the numbing sensation lasted. I would have preferred to use something that numbed to a greater depth, but such products are prescription-only and can require a pharmacy special order. So about 45 minutes before my appointment time, I used a spatula to apply an over-the-counter lidocaine cream to both of my upper arms and then I wrapped them in plastic wrap. I made sure that I was hydrated and then drove to the site.

After checking in, I cleaned off my arms with wet wipes and tissues. The plastic wrap trapped my body heat and activated the lidocaine, which I confirmed with my toothpick. Next, I rubbed some scented lotion under my nose to mask the triggering smell of isopropyl alcohol. Finally, I loaded a word seek game on my iPad as a distraction. I found the word “oil.” And “lean.” And “sel,” which I didn’t know was a word. This is where I was when I offered up my bare left arm.

“Relax.”

I could feel the needle, or at least a muted, more pressure-like version of a needle’s sharpness. Then it was gone, quickly. I exhaled deeply. The lidocaine had done its work. 

I’m still frightened of needles. I probably always will be. But, for me, the routine worked. This time. Would it work for others? Will it work for me on other procedures? Or will I need a new set of tactics and tools? I don’t know. I do know that some needle phobics have found ways — products, medication or therapy — to manage this issue so that it does not stand in the way of their health. Frequently, they do this on their own, feeling a lack of support from the medical community.

And sometimes they are ashamed to admit weakness in a world that values stoicism in the face of pain. After I posted my story and a vaccine selfie on social media, I received a message from my great-aunt, a former nurse. “Your dad wasn’t good with shots and needles,” she wrote. “You have it too!”

I never knew. Stunned, I think about what psychological dances my father must have done to navigate the relief he needed from the pain of metastatic cancer as it crushed his spine.

So medical providers, I am begging you, please do not tell your patients, “You can get over this.” Instead, look your patients in the eyes and say, “I will help you get through this.”