The Truth About Needle Fear with Amy Baxter, Founder & CEO at Pain Care Labs: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
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Saul Marquez:
Hey everybody, Saul Marquez here, and welcome back to the Outcomes Rocket. Today I have the privilege of hosting Dr. Amy Baxter once again. If you haven’t heard our podcast interviews with her, one of my favorite guests that we’ve had on the show, Episode 426, where she talks about the work that she’s doing with her company, Vibra Cool. The product is phenomenal. Buzzy another one. Episode 426 and then also Episode 520 where she goes deep on COVID-19 and some of the things that we should be thinking about, just a ton of really good content. Check those out if you haven’t already. But she founded Pain Care Labs in 2006 to eliminate unnecessary pain. She invented Vibra Cool Vibrational Cryotherapy for tendonitis and to decrease opioid use and her Buzzy device has blocked needle pain for over 35 million procedures. This is key in what we’re going to talk about today around COVID and vaccination. After Yale and Emory Medical School, she trained in pediatrics, child abuse, and emergency pediatrics. federally-funded for needle pain and fear, opioid use, and neuromodulation research she publishes and lectures on needle fear, sedation, and pain. Scientific contributions include hepatic enzyme algorithm to time child abuse, creating and validating the barf nausea scale for kids with cancer, identifying the cause of the needle phobia increase, and Buzzy and Vibra cool. She’s spoken on TEDMed. She’s done TEDx talks. The bottom line, she’s phenomenal. And we’re going to talk about some really great things today around COVID-19, needle fear, and a lot of her research that she’s actually doing and has done and is helping our nation today with the vaccination. So Amy, welcome back.
Amy Baxter:
Oh man, I feel so ADHD listening to that list.
Amy Baxter:
Well, you’ve got a lot on your plate. You’re certainly always keeping things interesting. And I appreciate you for that. And the listeners appreciate you for that. So talk to us a little bit about what you’ve got going on. You know, we sort of got reconnected with this topic of needle fear. So why don’t you introduce your work there and the relevance today?
Amy Baxter:
Sure. Sure. Well, you know, for anybody who’s heard before the story thus far was that I invented a device that used mechanical vibration to block needle pain, got a grant for it, found that it also decreased other pain, kind of did some work with needle fear, needle pain, and found that Americans really didn’t care that much. So that’s why I did the TED talks. That’s why I did the Ted X is to raise awareness of the fact that the way we are vaccinating kids causes adults to stay afraid of needles. But because I’ve got this company in this product, I moved on to Vibra Cool opioid stuff and all of a sudden needle pain is relevant again.
Saul Marquez:
Yeah, well, it is. And it’s a big deal today because we’ve got two vaccines available as of now. We’ve got one more coming with the J&Jay. And more and more people are getting the vaccine. Many are not. And so talk to us a little bit about your research. I’d love to hear more about it and how it is impacting people’s willingness to get vaccinated today.
Amy Baxter:
Sure. Well, the cool thing is that I’ve actually been asked to testify for the Department of Health and Human Services on needle fear and needle pain. It had never been an issue before and it probably wouldn’t have been an issue if the strains of COVID-19 stayed the way they were. If they are not, if that transmissibility number was at two or even two point five, we only would have needed 60 percent of the population to be vaccinated. With the B117, with the South African variants, all of a sudden now you’re talking about needing 70 percent, 75 percent of the population to be vaccinated. The issue with that is it 20 percent of people said they’re not getting a vaccine anyway. No how. And this means that you need to start working on those people that may get one, but not get the second one. So that’s where all of a sudden it became important to really look at needle fear, needle dread, fainting, anxiety, pain, all of these issues that may be enough of a barrier to someone that they’re not going to get that second vaccine and then they’re only 50 percent covered. Or for the people who are going to freak out and don’t get the first vaccine, not because they think there’s a conspiracy or not, because they’re afraid of your immune system and their body being co-opted by space aliens with lasers, but because they just can’t bring themselves to stand getting that first shot.
Saul Marquez:
Yeah. Now and the obstacles there. And obviously, it takes a pandemic to make some differences in a lot of ways. Right. on the digital health front. Wow. What we’re seeing in telemedicine and telehealth and digital health and needle fear.
Amy Baxter:
So you don’t see what you don’t see. Right. So doctors don’t see the people who have fear because they don’t come to the doctor and pharmacists don’t see the adults who are afraid of needles because those aren’t the ones who come voluntarily to get their shots. We started in 2009 looking at a device to block needle pain. What we found that was fascinating was that the 10 to 12-year-olds who were supposed to about twenty-five percent of them were supposed to be afraid of needles, about 10 percent of adults. But when we looked at the Buzzy for needle pain and asked these kids how afraid of needles they were, ninety-five percent of them said they’re afraid of needles, which is crazy. It was way more than it should have been. So part of the grant that we got from the SBI or the National Institutes of Health Small Business Innovation Grant, we went back to these kids vaccine history. Did you know that up until 1983 there were only six injections on the vaccine schedule? Only six POCs up until 1983. That’s I was born in sixty-nine so I would have only gotten six injections. You got them all before you were two years old and we didn’t remember. So we think we’re cool and we think that everybody else is afraid of needles is wimpy. But the reality is that kids born in the year 2000, which is when our studies kids were born, they got thirty-six separate injections before they were six.
Saul Marquez:
Is that right?
Amy Baxter:
Yeah. So all these twenty-eight percent of adults are afraid of needles now. And the reason is because we started giving kids a lot of injections on the same day when they were old enough to remember. It’s not even the thirty-six shots. It’s just the ones when you’re old enough to remember.
Saul Marquez:
So before two, you got six.
Amy Baxter:
Now they get twenty-one.
Saul Marquez:
So now it’s twenty-one before two?
Amy Baxter:
Yeah but that’s ok. Honestly, you can stick them like a pincushion before they’re two. It’s important we’re saving lives. They don’t remember.
Saul Marquez:
And that’s the factor here.
Amy Baxter:
Yeah.
Saul Marquez:
Gotcha. How does your Buzzy work then? There’s the psychological factor and then there’s the actual pain factor. So I mean let’s talk about those two.
Amy Baxter:
Yeah. And it turns out it’s even more complicated. We have learned so much in the last ten years about how pain is perceived and what actually impacts both compliance with injections and also with pain. It turns out that the Buzzy, it uses a very specific frequency that jams the pain nerve. So it’s like if you bump your elbow and you rub it or if you bang your hand with a hammer and you shake it, you don’t feel pain. What you’re doing is you’re stimulating this one specific A-beta nerve that has the ability to block out pain and it responds to a specific frequency. So Buzzy uses that frequency, blocks out pain by vibrating on your arm while you’re getting the shot so you don’t feel it. OK, cool. Except that a lot of kids still freaked out, even with just having an alcohol swab like on their arm. So like you said, it’s not the pain, it’s something else. What we identified for kids is that it’s a combination of pain, fear and how much focus they have. A lot of people early on thought Buzzy was a distraction because I made it cute because I’m a pediatrician. But the reality is that it helps to have some other distraction. Buzzy does the pain part. But you need to have something to stare at, something to look at, something to make you laugh, to trick your brain into not perceiving a threat. Pain is a threat, but if your brain is concentrating on the game, then you don’t perceive the pain as much because it’s not a threat. Like if you’re running and you twist your ankle and you’re almost going to win, your team is ahead. So you get up and you keep moving. You don’t really feel how much your ankle hurts until after the game’s over.
Saul Marquez:
Yeah, that’s really interesting. And then there are things like virtual reality or augmented reality for pain. What are your thoughts on that?
Amy Baxter:
So the distraction part that virtual reality does is exactly the same thing that you could do yourself if you’re afraid of needles by looking at a sentence on the wall and counting how many letters have circles in them. So if you’re doing something that’s outside the norm and you’re completely absorbed in it and it takes a lot of effort, that is enough distraction to reduce pain 50 percent. So virtual reality is using the anterior cingulate gyrus, anterior cingulate cortex. Some would say it’s the place where your brain evaluates risk and it sets up problem-solving. You can’t do a math problem to distract yourself from pain because solving problems is in a different area of the brain. But the place that’s analyzing am I at risk from this pain is also the same place that’s analyzing how do I win this game or how do I count those letters that actually I’m not counting all the letters, I’m just getting some of the letters. So virtual reality is fantastic. Buzzy, actually, in one study was found to be as effective as virtual reality for decreasing neuropain.
Saul Marquez:
That’s fascinating. And so let’s dive deeper into this. So you’ve got this device that can help. There’s a lot of education that has to happen, though, right? I mean, there’s a lot that has to happen there.
Amy Baxter:
Yeah, well, and of course, step one, identify the problem. Nobody really cares about kids and needle pain in this country because you can hold them down. And so it’s not a problem that’s been recognized until now. Once you have lived with needle fear your whole life, it becomes a lot more difficult as a 30-year-old to then be told you need to go in front of strangers and get two vaccines a month apart. And if anything goes wrong, anything. If someone makes you ashamed, if someone says, yeah, you better sit there, this is really going to hurt anything like that’s going to be hard. So I think that the great thing about the HHS having its vaccine advisory committee meeting is that they’re acknowledging that there is a problem. The second thing is so Buzzy is not going to be the end-all and be-all for everyone. It is a source of control that’s important. It is a source of pain relief. It does seem to block the Bay of Bengal response. So that passing out thing. But a lot of people who are older and have lived with needle fear for a long time, they’re as much afraid of that rising panic that’s going to embarrass them in front of people.
Amy Baxter:
So anything that they can do that can work it is helpful. We got a Twitter, actually, somebody on Twitter two days ago said Buzzy helps, you helped me keep my dignity intact when I got vaccinated in front of complete strangers over 30 years dealing with my trauma. And today I walk out feeling more free than I ever have before. Thank you. And that’s the thing. It’s not the pain necessarily. It’s the fact that these people are ashamed and they have been made fun of and they know they need to get health care and they’re not. So the pain is less the big deal, but the training is going to be important. So that’s why having a national forum and making people who give vaccines for a living aware that we have made a generation of young people more likely to be afraid of needles and there are ways to back people off of that ledge. But we’ve got to be empathetic about all of the different kinds of needles because they are already adults.
Saul Marquez:
That is so fascinating. And some of the perspective that you’ve given us Amy is very interesting. You know, like this whole transition from kids in the time frames and how many more vaccines we get or shots that we get. And then beyond that age where you actually remember, I didn’t know that.
Amy Baxter:
Most people don’t. And we assume the same thing happened to us that happened to our kids, that happened to our parents. It’s been a very radical, healthy addition of the injection.
Saul Marquez:
When was that cut off or you mentioned the year? I think you said 2000, but I think that was just the year that your study patients were.
Amy Baxter:
Well, there are two big numbers that I talk about. One is 1983. When we started adding boosters when kids were old enough to remember. The second year is 2000 because what happened in 2000 was we changed oral polio vaccines to injected polio. So that added four more doses and we added flu down to age six months. So we’re adding a yearly dose of flu at age four or five and six, and we’re adding the injected polio sometime between four or five and six. And we have all of the other booster’s between four, five, and six. This is what we found in our study that was interesting. The kids whose parents were like, oh, I don’t want them to get two shots in one day because it was your immune system. It doesn’t hurt your immune system. But those kids got resilient. None of those kids were in the highest quartile of fear as pre-adolescence. The people who got two injections and their parents brought them back a couple of different times, even with two, only nine percent of those kids were afraid of needles five years later. But the kids who they’re like, oh, let’s get it over with. Let’s get them all done on the same day. If you got four or five injections on the same day, 50 percent of those kids were severely afraid of needles five years later, and we followed them another three years and they were two and a half times less likely to finish their HPV series. And I guarantee you, those are the ones who are going to be a problem getting their second COVID vaccine.
Saul Marquez:
Yeah, that is fascinating. So tons of misinformation about how to address this fear. Amy, talk to us about how to address it. How do we how do we do it?
Amy Baxter:
Cool. Well, so if you want to talk about how to use Buzzy, which is a part and can be a part but doesn’t have to be the only part, so it’s a vibrating device. It’s got an ice pack that you can use. It does extra pain relief. If that’s your issue. You put it on the site for about 60 seconds and then while you get the shot, you slide it up a little bit. So it keeps disrupting those nerves while the needle goes in. Then you can rub it over the site afterward. Now, this does two things, it helps with any pain that’s residual. It helps block any kind of feelings of lightheadedness. But it also seems to be helping all of the nurses who are using it with their COVID shots not get sore arm. So this is one thing I’m really hoping is that we can incorporate this in at least some of the centers with the V-safe app that’s being used to track vaccine side effects to see if indeed using BuzzY can stop that, that sore arm thing. But otherwise, for people who know pain is not as big a deal, control as a big deal. So having time to go, having a person go with you, being able to have someone to help you distract at the time of the injection itself, if fainting is an issue for you, then being able to either bring a seat or having a place in the vaccine area where you can sit down. For people who faint a lot, you can eat a lot of salt the day before or salty foods and then drink 16 ounces of water about an hour before the injection.
Amy Baxter:
So the salt helps you keep it in your veins and then the water helps your blood pressure not drop while you’re getting the injection. Another thing that are important are being able to control the situation. So not being seen by other people, having a place that you can choose, having a distraction you can choose, and above all, having empathetic people that are vaccinating that listen. One of the biggest things I hear is people say, look, I know what happens. I’m going to pass out unless you don’t tell me when you’re about to stick. And I’m going to look over there and I’m going to squeeze my stomach so I don’t pass out. And then what does the person do? They say, all right, here comes the stick, and then every person is afraid, loses it. So it’s complicated and not everything fits for everyone, but being able to let individuals choose what they want, choose being in spin control and make it as fast and understanding as possible, that’s really part of what we’re going to have to do to chip away at those additional 10 to 20 percent who aren’t going to get their first or second vaccine.
Saul Marquez:
Some really helpful tips. Thank you for that, Dr. Baxter. I think it’s a fascinating approach and I think one that we need to be very, very conscious about, whether you’re a patient to know what exactly you want because you are you’re going to need the vaccine or if you’re a provider and you just want to be understanding and understand some of these things that you could recommend to your patients, I think it’s critical. And so we really appreciate this perspective that you’ve given us today. What should we walk away with? What do we keep in mind as we work to get our loved ones the vaccine? Ourselves? What do you want to leave us with?
Amy Baxter:
I will feel like a success on Thursday evening if these things happen with my testimony. First, if we realize that we do need to pay attention to four to six-year-old injections and decrease the pain and the trauma. Trauma sounds so hard for an adult who’s not afraid of needles. But as the quote I just read, you said these kids grow up and are really traumatized by their shame and their fear so we can change the way we do vaccinations, keeping them in that four to six year period. We don’t have to change the vaccine schedule at all. We’ve just got more flexibility or we address the pain. The second thing, getting a vaccine is the only way we’re going to get back to normal life. And we will we are going to get back to normal life. But if we do it in summer of 2021 one or we do it in 2023, that depends on everybody who can getting vaccinated. So this is something that a lot of people have let their fear of vaccines come from a fear of pain. And so they’re coming up with all these reasons why they don’t want to get vaccinated. And if those people can realize that there’s some part of a bad experience that is contributing to that, maybe they can let those things go to go ahead and get the vaccine and help everybody in society.
Amy Baxter:
And the third thing is, if you are one of the sixty-eight percent of people that are not afraid of needles, quit feeling so proud of yourself. This is not something you did that made you awesome. It is that you had a really different experience than a lot of other people did. So if we can quit making whether you’re afraid of needles a weakness or a pride or a moral thing and accept that this is the only time in humanity where we regularly give small children sharp sticks from their parents. That’s the last two hundred years before that last hundred years, we didn’t do it. So it’s a new thing for humans and we’re learning how to do it right. So let’s be a little grace-filled for the people that are afraid of needles and instead figure out how we can all work together to get all of us past this virus and onto seeing each other in person, going out for drinks, and giving hugs.
Saul Marquez:
Yeah, you know, you do such a nice job of taking a step back and giving us the macro view of some of these really challenging topics. So I just want to say thank you. Thank you for the work that you do. And on behalf of all of us, thanks for what you’re going to do here in a couple of days to hopefully make an impact for our kids and everybody in our country moving forward. So thanks. Thanks again.
Amy Baxter:
It’s going to be fine.Saul, thank you so much for what you do. And thank you for having me.
Saul Marquez:
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