Needle phobia: a neglected diagnosis

Journal of Family Practice,  August, 1995  by James G. Hamilton

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The depth and effectiveness of topical anesthesia is greatly enhanced by the technique of iontophoresis (or ionphoresis). Iontophoresis involves soaking an absorbent pad with lidocaine and driving it through the skin with a tiny electrical current from a battery-powered unit.(35)(56) Because lidocaine is a positively charged molecule, the electrode pad's positive charge repels the lidocaine, propelling it through the skin by way of the sweat ducts. Using iontophoresis, an injection or venipuncture site can be completely anesthetized to a depth of 1 to 2 cm in less than 10 minutes.(56)

The procedure of iontophoresis has been assigned insurance reimbursement codes, and an iontophoresis unit(*) for use with needle phobic persons has been cleared by the Food and Drug Administration. This instrument has been demonstrated to be effective for venipuncture and joint injections(56) and has applications, for example, in blood donor drives(35) and pediatric immunization programs. The ease of use of iontophoresis raises the intriguing possibility of creating in the near future medical environments that are completely free of needle phobia.

Acknowledgments

The author wishes to thank Nancy R. Hamilton, RN, for her most gracious patience and support during the preparation of this paper, and also Gary Hadden, Department of Psychiatry, Duke University, for his expert assistance.

References

(1.)Ellinwood EH, Hamilton JG. Case report of a needle phobia. J Fam Pract 1991; 32:420-3.

(2.)Hamilton J, Ellinwood E. Needle phobia [abstract]. South Med J 1991; 84(Suppl):2S-27.

(3.)Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994:405-11.

(4.)Marks I. Blood-injury phobia: a review. Am J Psychiatry 1988; 145:1207-13.

(5.)Galena HJ. Complications occurring from diagnostic venipuncture. J Fam Pract 1992; 34:582-4.

(6.)Jacobsen PB. Treating a man with needle phobia who requires daily injections of medication. Hosp Community Psychiatry 1991; 42:877-8.

(7.)Hsu LKG. Novel symptom emergence after behavior therapy in a case of hypodermic injection phobia. Am J Psychiatry 1978; 135:238-9.

(8.)Lemasney NJ, Holland T, O'Mullane D, O'Sullivan VR. The aetiology and treatment of needle phobia in the young patient--a review. J Ir Dent Assoc 1989; 35:20-3.

(9.)Wambaugh J. The blooding. New York, NY: William Morrow, 1989:210-4, 217.

(10.)Schmerber v California, 384 US 757, 86 SCt 1826 (1966).

(11.)Breithaupt v Abram, 352 US 432, 77 SCt 408 (1957).

(12.)South Dakota v Neville, 459 US 553, 103 SCt 916 (1983).

(13.)Hammer v Gross, 932 F2d 842 (USCA, 9th Cir, 1991). cert denied, 112 SCt 582 (1991).

(14.)Boas EP. Some immediate causes of cardiac infarction. Am Heart J 1942; 23:1-15.

(15.)Cass N [letter]. Anaesth Intensive Care 1978; 6:169-70.

(16.)Dale WA. Cardiac arrest: review and report of 12 cases. Ann Surg 1952; 135:376-93.

(17.)Kulvin MM. Scared to death [letter]. JAMA 1966; 198:90.

(18.)Lockey RF, Benedict LM, Turkeltaub PC, Bukantz SC. Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol 1987; 79:660-7.