How can you beat a fear of needles?

MY 15-YEAR-OLD granddaughter has a severe needle phobia.

She is two years behind with her immunisations, including meningitis, and recently could not have a blood test.

But on two occasions — for dental fillings and a tetanus jab at A&E — she was able to have injections while under inhalation sedation.

Why don’t immunisation teams and GP surgeries have this equipment? Philip Nash, Sutton Coldfield, W. Mids.

MoST childhood fears, such as fear of the dark, are a normal part of development and children will grow out of them.

But with phobias, which lie at the more severe end of the anxiety spectrum, the child has an overwhelming and exaggerated fear of something, to the point where it causes a significant problem in their life.

For example, your granddaughter’s dread of needles means that she cannot finish her immunisation programme.

She has already had two ‘positive’ experiences, where she accepted an injection after being sedated with nitrous oxide. I feel it would be helpful to build on this.

But first I shall outline some of the other possible coping strategies.

In your longer letter, you tell me your granddaughter is being seen by the Childhood and Adolescent Mental Health Services (CAMHS).

The options available depend on the skills of the specialists in your local team, who may be psychologists, psychotherapists, child psychiatrists and specialist nurses.

one technique is applied tension: the patient is taught to tense the muscles in their limbs until they feel a warm sensation in their face, then release for 30 seconds.

They repeat the cycle several times that session, then practise it at least once a day for a month.

The aim is to bring blood pressure back to normal — some people find the prospect of a jab causes their heart rate and blood pressure to rise and then drop rapidly, leading to fainting.

Studies show patients who use the technique at their next injection may find their anxiety has reduced.

Another option is cognitive behavioural therapy (CBT) to reduce negative thoughts and avoidance tactics before an injection.

As with applied tension, mastery depends on the therapist’s skill, the patient’s co-operation and determination and months of training.

A third technique is hypnotherapy. I worked with a doctor who used this technique on children aged two to four who were having blood tests. She would hypnotise them — gently talking them into gazing at a toy or watch — before painlessly slipping in a needle. It was impressive.

There is also medication. A minor tranquilliser, usually a diazepam tablet given half an hour before, along with a powerful local anaesthetic gel is usually effective in adults.

However, you tell me your granddaughter has been offered this in the past and rejected it. And as she’s had success with nitrous oxide inhalation, this should be the route to go down.

The gas used is called entonox — 50 per cent nitrous oxide and 50 per cent oxygen. It is effective and fast-acting, providing pain relief and inducing relaxation.

entonox is widely used by the ambulance service and in A&e, but rarely in general practice. This is because the call for it in the community is limited.

And, as with many specialised techniques, using it correctly and safely requires experience and training. Furthermore, there is a strict policy around the safe use of medical gases.

I would hope that with the support of CAMHS, your granddaughter will be able to have her immunisations in a hospital using entonox.

This may help form part of her treatment plan for the phobia. MY DOCTOR thinks that I have fibromyalgia, and I am bemused about several points.

I was prescribed low-dose antidepressants, but I was worried about dependency, so stopped taking them. I walk two or three miles a day because I fear that otherwise I will need a wheelchair.

Would it help if I lost weight? And will it get better? I am 70.

Name and address withheld. THe diagnosis of fibromyalgia often raises more questions than it answers. Though it is common (affecting 8 per cent of 65-year-olds), it is a diagnosis of exclusion — there is no test to prove conclusively someone has it, and there is no proven effective treatment.

The main symptom is widespread pain affecting muscles, ligaments and tendons (ligaments tie bones together, while tendons join muscles to bones). The patient may also experience migraines, irritable bowel syndrome, fatigue and depression. Though chronic, the pain varies in intensity and is made worse by anxiety, insufficient sleep, exertion and even weather.

Fibromyalgia is thought to develop because of a change in how pain is perceived by the brain — a phenomenon called ‘central sensitisation’.

while the exact cause is not clear, there seems to be a genetic tendency which, when combined with infection, injury, emotional trauma or disturbed sleep, allows fibromyalgia to develop.

Diagnosis is based on the patient’s history and on investigations to exclude conditions such as arthritis. we also assess the response to pressure on 18 trigger points — if 11 or more show excessive tenderness, this is strong evidence it’s fibromyalgia.

LeT me reassure you it is not degenerative — it won’t cause your body to stop working — nor is it life-threatening. As for treatment, antidepressant drugs at far lower doses than for treating depression can be effective at reducing pain and improving sleep, probably by acting on parts of the brain that have become altered by central sensitisation.

I must stress these drugs do not cause dependency, unlike codeinebased painkillers or diazepambased tranquillisers.

I know of no evidence that weight loss will help, but if your body mass index is above 30, losing weight will be key to protecting other aspects of your health.

we do know that regular exercise helps to improve strength and reduce widespread pain, partly because it boosts endorphins, our natural painkillers. At least half an hour of exercise three or more times a week is recommended.

There is evidence CBT can change the way you perceive pain.

Tai chi, an exercise combining deep breathing with gentle movements, may be of value.

As to whether it will get better, yes, it should. Be reassured, while there will be bad days, there will also be good days.