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EMILY KWONG, BYLINE: Back in March of this year, Tom Tomezsko got a call from his local CVS. They could give him a COVID vaccine, the first of two doses, if he could rush over in 10 minutes.
TOM TOMEZSKO: And so that was actually pretty ideal for me because I didn't have the time to stress about it. It was kind of just like go mode.
KWONG: See; since he was a kid, Tom has always had a hard time with needles. It's not really about the pain for him, he says, but the idea of needles. And over the years, he's figured out some tricks to deal with this.
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TOMEZSKO: I am pretty well-versed in getting myself through shots and vaccinations at this point. So I grabbed a whole lot of water. I grabbed mint gum. I grabbed candy. And I grabbed a bag of frozen peas. And it sounds like a kind of silly collection of things. But I know for me, right after I get a shot, that's really when I feel it. And that's really what is just distressing to me.
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KWONG: Right after any shot, Tom says his blood pressure crashes like an elevator with a cut cable. He gets sweaty, dizzy. He'll sometimes pass out. That's when his supplies come in handy. And when he finally got to CVS for his COVID vaccine, he was ready.
TOMEZSKO: So I put the bag of frozen peas on my head to cool me off and kind of keep me grounded in that sensory way, and chewing mint gum to help settle my stomach and then eating candy to get my blood sugar up, to get some more energy. But it was really nice to not have the date set in advance so that I wouldn't stress about it for a long time ahead of time.
KWONG: And Tom also got through his second vaccine dose. This one scheduled for a month out.
TOMEZSKO: So I had more time to worry about it. But it wasn't horrible.
KWONG: Now fully vaccinated, Tom, a student, wrote about his fear of needles recently for a journalism class. He interviewed people like himself. He interviewed experts. And he says, through that, he finally had the language to understand what he and others have been going through all their lives.
TOMEZSKO: I totally felt on my own and kind of out to see kind of like working in all these like homespun ways to cope and get through needles. And I had no idea that this was bigger than me, really, and had a name.
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KWONG: Today on the show, we explore needle fear with clinical psychologist Meghan McMurtry.
MEGHAN MCMURTRY: Well, I think congratulations should be given to Tom for managing his fear and his anxiety around needles. And I think he's figured out some strategies that really work for him. And some of them really do have a basis in science as well.
KWONG: We'll talk about some tools to help people cope, the key role of clinicians and why it's important to address needle fear beyond the pandemic.
I'm Emily Kwong, and this is SHORT WAVE, the daily science podcast from NPR.
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KWONG: OK. Today we're talking to Meghan McMurtry, an associate professor in psychology at the University of Guelph. She's also director of the Pediatric Pain, Health and Communication Lab. And looking at the best estimates, Meghan says one in 10 people experience a high level of fear of needles and that they'll delay or avoid vaccinations because of it. But she says, we need to really think of fear and anxiety around needles as a spectrum.
MCMURTRY: And so when we think about needle fear, it can be a combination of sort of low anxiety and fear right up to extreme anxiety and fear. And when we have that combination of extreme anxiety and fear, the anxiety is going to lead to people wanting to avoid even talking about needles, seeing pictures of needles, definitely going to get one they want to avoid. And then that combined with extreme fear, that leads to wanting to kind of escape the situation when they're in it, right? It's quite a strong response. And so that really high, high level and combination of fear and anxiety can meet what's called blood injection injury phobia, which is really a mental health diagnosis. So often, you know, people are referring to needle phobia out there in the media. And not all levels of needle fear, you know, warrant a diagnosis of a phobia. That's really the extreme end. But we need to care about individuals who have even higher levels of needle fear or sort of at that high end even if they don't have a diagnosis of a phobia because they still may be really sort of suffering and avoiding health care. And so we want to be able to help them if we can.
KWONG: Yeah. The thing that's really interesting about having this conversation now, of course, is we're obviously in the middle of a pandemic and a big public health moment where we're trying to get as many people vaccinated as possible. And that vaccine is delivered through a needle system. How do you think we're all handling needle fear right now?
MCMURTRY: Right. So I think that this area around needle fear and pain related to needles has had much more, of course, attention paid to it in the context of COVID and even sort of vaccine hesitancy more generally. So I'm focused on the pain and fear related to needles. And certainly, I think, we have an opportunity to not only make needles more comfortable in the context of COVID and delivering the vaccinations, but also in terms of just moving forward in health care. And I think we have a responsibility not only as individuals who are getting the needles ourselves, but caregivers for individuals who are getting needles, clinicians who are delivering the needles, as well as people who are in charge of setting these clinics up.
KWONG: Yeah. I'd love to hear about what some of those best practices are. What can be implemented in doctors' offices and clinics to ease people's anxiety and make it more comfortable for them?
MCMURTRY: Right. So when we think about, like, setting up your clinic, for example, let's take it at sort of...
KWONG: Yeah.
MCMURTRY: ...The broadest level. You want to...
KWONG: OK, I'll imagine the clinic as you describe it. Go on.
MCMURTRY: So you want to imagine a clinic that has a reasonable temperature in it. When we think back to Tom - right? - we don't want a hot, stuffy kind of office or a freezing cold...
KWONG: No.
MCMURTRY: ...Office - right? - or area. We want to have comfortable seating. We want to have sufficient space. We want to make sure that when people are waiting to get their vaccination, that they're not standing for long periods of time because that's actually a risk factor for fainting. And we also want to make sure that people who are getting the vaccination aren't kind of on display for everybody who's waiting - right? - because that can kind of drive up the fear in the person being vaccinated. And if they have any kind of reaction, then that can be very alarming to people who are watching, right? And so it's really important to have kind of, like, a single entrance and then a different exit, so you're managing the clinic flow in a way that keeps things calm and kind of well-managed.
For the clinician, they should be supporting people who are getting those vaccinations by, you know, talking to the person who's getting the needle and saying, do you want to look at the needle? Do you want to look away? You know, how can I help you get through this? Is there something that you're going to be doing to distract yourself, you know? Is there something that you want to talk about? We want clinicians to be honest, but also allow, you know, for differences in patient experience - so not to say it definitely won't hurt, because that's not necessarily true. And then if it does hurt, you've lost credibility. So allowing...
KWONG: Yeah.
MCMURTRY: ...That kind of space to talk about the person's experience - it doesn't have to take a lot of time. And in fact, asking about whether someone is, you know, concerned about anything or how confident they're feeling can allow the clinician to understand how best to help the individual who's in front of them.
KWONG: What I like about this is it's inviting both the medical practitioner and the person getting vaccinated to be a part of making a better experience (laughter). Like, I think it requires, I imagine, some degree of self-knowledge. If you're someone who has needle fear, asking yourself, like - what is it that would actually help me? - and then being able to communicate that to a medical provider, which can be kind of intimidating sometimes.
MCMURTRY: Absolutely. And then think about the context - if you're pretty afraid...
KWONG: Yeah.
MCMURTRY: ...Your ability to kind of hold all of this in mind and advocate for yourself could be very challenging, right?
KWONG: Right.
MCMURTRY: So making a plan beforehand is really important. And so certainly, something that is led by my colleague, Dr. Anna Taddio, is the CARD framework, which is an acronym. So C stands for comfort. A stands for ask. R stands for relax. And D stands for distract. And it's about sort of making a coping plan for what you're going to do under all those categories and what you need, you know? So Tom has really come up with his own coping plan that works for him. And that's fabulous. But some people might need a little bit more help - right? - in doing that? And often, people with really high needle fear actually need to have that worked on before they can kind of really benefit from a coping plan that's sort of more put in place at the time of the needle.
KWONG: That's very helpful. We're going to link this research-backed CARD system in our episode notes if you want to check it out. For people who have a history of feeling faint or dizzy around needles, what are some things they can do heading into a vaccination?
MCMURTRY: Great question. So it's really important for them to tell the clinician that they have a history because the clinician needs to know that. And there's a particular strategy called muscle tension that is recommended, which can help. So the idea is that people faint during needles because their blood pressure and heart rate initially increase and then suddenly decrease. And it's this sudden decrease that leads to the feelings of dizziness or, you know, actual fainting. So what people can do is muscle tension, which is designed to keep their blood pressure up so that they don't feel dizzy or faint. And muscle tension really just means tightening large muscle groups in their body for, you know, 20 to 30 seconds until they feel flushed in their face. And then they release them. They don't relax fully, but they just release them back to baseline for 10 or 15 seconds. And then they repeat that tension. And they do this before, during and even for a little bit after the needle to ensure that they're not kind of feeling that dizziness. And it may be that they want to ask also to lie down when they're getting their needle as well.
KWONG: I'm wondering if there is any way you wish people working on this pandemic would think about needle fear differently?
MCMURTRY: I guess I would even make a bigger wish...
KWONG: Yeah.
MCMURTRY: ...Which is for all of us to think about needle fear differently - that it's not somebody's choice to simply be afraid, and that we can all take steps to support individuals in facing their fear and having comfortable needle procedures, because they're so important to health care generally. A lot more attention has been paid during the pandemic. But, you know, needle procedures are used to diagnose, prevent, monitor, treat health care conditions, you know, across the lifespan. So I think we all have a responsibility to kind of make them more comfortable.
And that - you know, even things like not showing in the media pictures of someone making a horrible face when they're getting their needle injection - right? - because what message does that send? I've actually tried really deliberately not to use the word shot because it sounds, like, quite violent, actually, right? The way we talk about needles in our everyday language, I think, can be a bit problematic because we tend to really dismiss needle fear. But if you were someone who was experiencing high levels of needle fear, you would know it's not something that should be dismissed.
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MCMURTRY: And so I think we have a lot to do in terms of how we talk about and present needles, as well as, really, that kind of empowered, patient-centered care model and kind of empathic approach. But, I mean, clinicians and patients working together to create comfortable procedures, I think, is a really important goal for health care generally. And we've come a long way with that.
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KWONG: Thank you so much for talking to us about this.
MCMURTRY: Well, thank you for inviting me.
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KWONG: Today's episode was produced by Rebecca Ramirez and Viet Le. Viet also gave this piece a stellar edit. Meanwhile, Berly McCoy did some excellent fact checking. The audio engineer for this episode was Stu Rushfield.
I'm Emily Kwong. Thanks for listening to SHORT WAVE, the daily science podcast from NPR.
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