Fear Itself (Not Fear of Needles) Is the Only Thing to Fear

In his first inaugural address, President Franklin Roosevelt may have said “The only thing we have to fear is fear itself,” but try telling that to someone who knows he or she is going to get a shot at the doctor’s office!

FDR was on the right track when it comes to fear—seriously, we all are afraid of too many things that just aren’t a threat. But a fact of the matter is this:

Humans have many fears.

A second fact is this:

Most fears are completely needless.

When looking at the top 10 fears, we find things like acrophobia (heights), ophidiophobia (snakes), and cynophobia (dogs).

Sure, falling from a height can be problematic and some snakes are poisonous, but the odds of plummeting from a tall structure—natural or manmade—is quite low and snakes will usually leave you alone if you leave them alone.

Now, we fully understand the role a previous bad experience with a dog can play in leading to cynophobia, but a bad experience with a dog is rarely the dog’s fault. Almost always, the true blame lies with a human.

(Seriously, dogs are awesome and we could all learn a thing or two from them!)

Something else you can find in the top 10 fears is trypanophobia.

What the heck is that?

Trypanophobia is a fear of needles and injections – and it’s more common that you would think. In fact, it’s an even bigger fear than public speaking!

And, as with most fears, this is one you shouldn’t need to worry about (provided the injection is being performed in a professional medical office!). Let’s look at why that is.

To start, it’s worth noting that many people tend to make the injection something much bigger than it actually is in their mind. You just know they walk in thinking “This is going to hurt, it’s going to hurt, it’s going to hurt!” Then a doctor finishes the injection and hears a patient say “That’s it?”

The reason for this psychologic buildup will often stem from either a personal bad experience or hearing about someone else’s.

Thinking about that, we should probably clarify something:

Injections shouldn’t be painful, but the “shouldn’t” modifier is important.

Whereas injections should not cause pain, many physicians are—surprisingly, perhaps—not actually trained in the best techniques for injecting patients.

Yep, you read that correctly: doctors are rarely instructed in how to give injections.

And that is exactly why I teach a workshop on injections for first-year Family Practice residents. After all, using the right technique is everything when it comes to keeping injections as painless as possible. And I want all patients—mine or otherwise—not to have pain from the experience and develop trypanophobia.

When the residents are done with the workshop, they head out in the world, confident in their ability to inject others in the most painless way possible.

With regards to proper technique, a slow injection is going to be better than a rushed one. Why? Because it gives anesthetic a chance to get ahead of the needle – and anesthetic always works (as long as it’s administered in the right spot!).

When local anesthetic is used, the area should become numb right away. To help with this, we adjust the pH balance—and may use a combination of short- and long-acting anesthesia—for optimal results. Between that and a slow, careful injection, we can make the experience as painless as possible.

Further contributing to our recipe for injection success is using syringes that are smaller.

Of course, like a clever magician, we also have a trick up our sleeve – distraction.

There are two different ways we can distract patients when performing an injection. The first isn’t as technologically savvy, but still works better than you would expect – and this is to have a patient tell us a good joke during the process. Often, the injection will be finished well before the punchline hits.

(If you are going to have an injection at your appointment, your challenge is to bring a good joke that will make us laugh.)

(“Dad jokes” tend to work quite well!)

The other, more technological distraction is physical in nature, and it’s something we found at a medical convention a couple of years back. We may use an instrument that has a vibrating element to distract the nerves from realizing that an injection is being given.

When the salesman at the convention made the claim that that’s what his product could do, I tried it out, injected myself and, what do you know, it actually worked like he said! Since it did, the sales rep got my business that day and our patients have been able to benefit – a true win-win.

Speaking of this, you should ask anyone—doctor, nurse, PA, etc.—if he or she would feel comfortable giving themselves an injection. If not, they really should not be injecting others!

There is one more thing—in addition to technique, syringe size, and distraction—that can make a world of difference for a good injection experience, and that’s how experienced is the doctor performing the injection. As with many things in life, this is a skill and it needs to be kept sharp with periodic (at the very least) practice.

Since we do have plenty of experience here, it’s easy to say that some areas of the foot and ankle are easier for injection than others. For example, the ankle and top of foot regions are relatively easy, but, by comparison, the bottom of the foot can be more difficult.

(Remember, skin on the bottom of your feet is 40x thicker than anywhere else on your body.)

One particularly cool injection is when we need do one in the sinus tarsi (a small cavity near the ankle). In this case, a 1 ½” needle disappears into an area that look as if it’s all bone.

In this instance, the key is that the area has a deep cavity. Within that cavity is a small nerve that can be compressed by swollen/inflamed tissue pressing against it. The injection reduces the inflammation and pain relief is felt instantaneously.

At the same time, there are places which are “no injection” zones – with the Achilles tendon being a prime example. Steroids should never be injected into this valuable connective tissue, and we’d tell you to run if a doctor is recommending this procedure, but you likely can’t run when you have Achilles tendon damage so it’s more practical to just say “no” and seek treatment elsewhere (like possibly with us!).

Although Achilles tendon problems shouldn’t be treated with injections, one condition that might be is plantar fasciitis.

With this common source of adult heel pain, corticosteroid injections are typically reserved as a basically “last resort” option. Given the effectiveness of orthotic therapy, we don’t need to use it often.

The reason we’re bringing it up, though, is because some people hear horror stories about plantar fasciitis injections. Well, if you do, now you can know they didn’t happen at our office!

A couple of quick, final thoughts about injections:

  • For children, sometimes the kids themselves are fine, but it’s the parents who exacerbate the problem.

To help with this situation, if your son or daughter is fine, there’s no need to build up the experience (even by saying that it might hurt). We are gentle and take extreme care with our young patients. Plus, like a magician pulling scarves out of a hat, we have one more trick we can use with them – we let them “help” perform the injection. (Basically, they just put a hand on top of ours as we administer the shot, but it works wonders!)

  • For whatever reason, redheads tend to anesthetize slower than other demographics. We’re not sure why this happens, but you will find that anesthesiologists agree (so it’s not just your favorite go-to foot doc who has observed this!).  This also comes from experience – I use to be a red head.

No, hair dye does not change this either way. If you are a natural redhead sporting brunette locks, it won’t speed up the process. And if you’re naturally blonde and have died your hair red, the anesthesia won’t take longer

  • It is incredibly amusing when a patient who has multiple tats and/or body piercings comes in and starts to freak out about how much the injection is going to hurt. The truth of the matter is that they have obviously been through more pain than we can possibly give.

At the end of the day, the whole buildup of injection fear can be like a long blog post – anticlimactic. When patients leave our office, they see it wasn’t really a big deal at all.

For information or to request an appointment—whether or not an injection will be needed—simply contact our office by calling (317) 545-0505.

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Indianapolis, IN 46216

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