From grown men crying and passing out to kids kicking me and refusing to get their ingrown toenails removed, I have seen the gamut of needle anxiety and fear. The fear of needles have resulted in the absolute refusal of some of the best methods to resolve acute pain. Because I know that in the majority of the cases an injection will help the patients ( there are rare cases where injections don’t help even when they should have) , I have, over the years, developed ways for patients with needle anxiety to cope.
As mentioned above, I have noticed such a wide range of reactions to people getting foot injections. This spans from no reaction whatsoever, to “it wasn’t as bad as I thought”, to screaming in pain like I was doing an amputation without anesthesia. I feel that this is a testament to the different wiring in our brain detecting pain and pain receptors in skin.
The following are 12 ways that have helped my patients and myself ( I hate taking a needle too ) over the years:
- MAKE SURE ANY GENERALIZED ANXIETY and DEPRESSION is MANAGED WELL and BE IN THE RIGHT MINDSET. Pain is perceived in the brain and it is well known that stress, generalized anxiety and depression can heighten perceived pain. So, first managing these conditions well with your practitioner can help one tolerate painful events better. Also keeping in mind that the pain from the injection lasts a brief time 10- 30seconds and staying focused on the benefits. Don’t ask the doctor how long the needle is or look at the syringe and needle. However, for some people watching exactly what the doctor is doing lowers their stress level in which case watch.
2. Make sure you have EATEN and are HYDRATED before your injection. I have seen people who take an injection on an empty stomach more likely to end up getting lightheaded and woozy .
3. USING ORAL ANTI-INFLAMMATORIES A FEW DAYS AHEAD OF TIME BEFORE INJECTION FOR AN AREA OF INFLAMMATION If an area of inflammation is being treated and if ok with your doctor, one can take oral anti-inflammatory medications ( like ibuprofen or naproxen) or use voltaren gel about 3-7 days ahead of the cortisone injection. This will decrease the inflammation to better tolerate the injection. Many times the strength of the cortisone is necessary to conquer the inflammation but the oral anti-inflammatory helps to knock it down a few notches ahead of time. I like to use anti-inflammatories and rest first for a few days before a cortisone injection especially with very inflamed new onset plantar fasciitis and big toe joint arthritis. The heel and big toe joint are the most painful areas in my opinion to have injected . **Always discuss with your doctor if it is ok to take oral anti-inflammatories . There are many dangers associated with these medications.
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Voltaren gel link on Amazon.
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4. USE LIDOCAINE PATCHES AHEAD OF TIME if not allergic to lidocaine or adhesive.
You can purchase lidocaine patches over the counter now. Lidocaine is a numbing agent. In some of my patients with needle anxiety, I would have them purchase the lidocaine patch and use to numb the area ahead of time. They are fairly large because they are designed for back pain. I’d have them cut the lidocaine patches and place around the area that was going to be injected about an hour prior to the appointment. See below locations and how the lidocaine patch is used .
Link to Lidoderm: https://www.amazon.com/dp/B01MF68INT/?tag=drgaffneybestfoot-20
** 5. BRING A LOVED ONE
Bring a loved one with you to the appointment. Studies have shown that being in the presence of a loved one can help reduce the intensity of pain. Sometimes even if a patient has come alone, I would have a nurse come in and be with the patient for moral support. This, I believe, helps by not being alone in your pain. My nurses were great at making patients talk and distracting them. Getting focus off the painful incident is important for coping. However, sometimes talking while the injection is occurring makes it worse for some patients, so just be sure to tell your healthcare team your preferences ahead of time.
**6. DEEP BREATHING TO GET IN A PARASYMPATHETIC STATE
Deep slow inhale in and out slowly . This steers your nervous system away from the fight or flight or sympathetic nervous system state to the rest and digest / chill out parasympathetic nervous system state. Start this during the ride to the office and during the entire time you are waiting. Deep breathing is greatly enhanced by breathing in lavender essential oil which helps one’s system relax.
Link for lavender essential oil (coupon code: SHAREYL for 10% off 1st order):
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**7. FOCUS ON MENTAL IMAGERY
While breathing slowly in an out, close your eyes and picture being in your favorite place like the beach, perhaps hiking trail ect, being careful to imagine the feeling of the experience with the sights, smells , ect.
**8. HAVE THE CLINICIAN PUT YOU IN the TRENDELENBURG POSITION
Have the practitioner lay you back specifically in a position the healthcare world calls the Trendelenburg position. This just means the head is lower than the feet making it less likely to pass out. A vasovagal reaction causes some people to faint when under certain stimuli of pain or stress there is a disruption of blood pressure autoregulation which decreases blood flow to the brain. So, the Trendelenburg position greatly reduces this. After I started putting all my patients getting injections in Trendelenburg all the time, I had no one fainting after an injection. Some patients have less stress and anxiety by watching the injection in which case don’t go into the Trendelenburg position. Other patients just don’t want to see it.
**9. HAVE THE CLINICIAN USE FREEZE SPRAY
Most podiatrists use a freezing spray called ethyl chloride prior to inserting the needle which freezes and numbs the skin temporarily. This generally helps tolerate the injection as well.
**10. ASK THE CLINICIAN TO PUT SODIUM BICARBONATE IN WITH THE LIDOCAINE
In a podiatrist’s office ,most, if not all injections contain lidocaine or a similar anesthetic. Lidocaine is acidic so it burns when its infiltrated. That’s why your doctor says “Its going to sting and burn.” The use of the freeze spray stated above helps the sting part. If the burning particularly bothers you with injections, you can ask your doctor to also put a little sodium bicarbonate about 0.1cc per 1cc of lidocaine to help alleviate the burning. However, most doctors do not have this in the office.
11. DON’T SUPPRESS YOUR FEELINGS of PAIN
Also, I have noticed that especially with men and kids trying to be tough and not show any pain reaction are more likely to pass out. So, I always encourage patients not to suppress reactions to pain and to yell if needed even curse. However, you want to approach the expression of your pain after you have been deep breathing and have focused on mental imagery as to not work oneself back up into the fight or flight sympathetic mode.
12. TAKE IT EASY WHEN ITS ALL OVERWITH
When its all over, have the nurse bring you back up to sitting position slowly. If you feel light headed, lay back down until the feeling passes. Do not get up too quickly. I suggest that patients with severe needle anxiety just sit in the room afterward for about 5 minutes to let their system re-adjust. If you continue to feel light headed or hot after receiving an injection, my nurses typically would apply a cold clothe on the forehead and lay the patient back down for a few minutes. My nurses were great for helping people with needle anxiety.
If worse comes to worst, then you can ask your clinician for a benzodiazepine like xanax prior to the appointment. I have had to do this a few times for my patients.
In conclusion, over the years the above mentioned tips have greatly helped my patients tolerate injections. I hope these help you in the future as well. Please leave any questions or any experiences you have had with receiving injections.
Thanks for reading and I hope this helps you next time you have and injection! Also, please check out my you tube channel and like and subscribe : https://youtube.com/@drgaffneybestfoot/?sub_confirmation=1
Leave me any comments, questions or suggestions for future posts!
Thanks for reading,
Melissa Gaffney, DPM
(Disclaimer: This blog is not Intended to diagnose treat or prevent any disease disorder or condition. It is for informational purposes only and does not constitute medical advice nor is it intended to replace medical advice. This blog does not constitute a doctor patient relationship. We disclaim liability for incidental or consequential damages and assume no responsibility or liability for any loss or damage suffered by any person as a result of the information provided. The information is provided “as is” without any representations or warranties, express or implied. One should always consult their doctor before starting any treatment or concerning any condition.)