How Numbing Creams Can be Helpful in Reducing the Pain Sensations Associated with Vaccination

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While many people are able to manage their nervousness and anxiety when it comes to needles and vaccinations, a high percentage of them can be fearful enough that it actually prevents their doctor or nurse from administering an injection or vaccine.

Needle fear (and persistent needle phobia) can even result in a host of negative consequences beyond taking blood or giving a flu shot, including vaccination non-compliance and even more general health care avoidance.^[1-3] With the current focus on the importance of vaccinations, methods to help overcome the fear of needles and vaccinations are more important than ever.

Chief amongst these methods include the use of topical anaesthetics that can help to reduce the pain sensations associated with vaccination,^[4-6] and in turn help children or adults to overcome their fear.

Needle Fear Among Children 

Fear of needles is a prevalent, yet under-appreciated and -prioritised health issue. Fear of needles is common in adults, with up to 38% of them experiencing it, but is even more prominent in children. In a study of 1024 children receiving immunisations, the self-reported fear of needles was scored as high as 68% of children aged 6 to 8 years, 65% of children aged 9 to 12 years, and 51% of children aged 13 to 17 years.^[4,7]  This can obviously make needle procedures a challenging and negative experience for the patients themselves, their parents or caregivers, and even health professionals.^[1]

Tips to Help Children Overcome Needle Fear

There are several recommendations and guidelines that are often used in combination for the management of the fear of needles and needle pain:

• Education of parents and children undergoing needle-related procedures (e.g., providing information in advance; what will happen – procedural information; how it will feel – sensory information; how to cope – managing fear and pain)^[4-6]
• Psychological relaxation and distraction (e.g., addressing the fear, comforting and accommodating the child, talking positively about prior experiences, reassuring the child, praising the child and offering a reward for after the procedure is completed, diverting the attention away from the needle during the procedure)^[4,5]  
• Topical anaesthetics (e.g., applying a topical anaesthetic cream such as Numit before vaccination can help to numb the skin and the pain of injection)^[6]

Numit – How Does it Work?

Numit is a combination numbing cream that contains two active ingredients (local anaesthetics); lidocaine (lignocaine) 2.5%w/w and prilocaine 2.5%w/w. These ingredients are known to be able to dull pain sensations in the skin by disrupting the generation of pain signals that are sent by the nerves in the skin to the brain.^[8] Numit can form a reservoir of the active ingredients in the skin during application, and these ingredients can continue to be released from this reservoir and numb the area even after the cream is removed.^[8] 

Numit can be applied in three steps ‘COAT, COVER and CLEAN’ before vaccination to help minimise the sting from the needle (Always read the label and follow the directions for use.):^[9]

1. COAT: Apply a thick layer of Numit cream to clean, intact skin. Refer to the product information leaflet for the appropriate dosage. 
2. COVER: Use an occlusive dressing (one that is air-tight and clear) to cover the area. Leave this dressing on for the recommended time according to the product information leaflet.
3. CLEAN: Remove the dressing immediately before the procedure and wipe off the cream. The doctor or nurse giving the vaccination can help to clean the area. 

References

1. McMurtry CM, Taddio A, Noel M, Antony MM, Chambers CT, Asmundson GJ, Pillai Riddell R, Shah V, MacDonald NE, Rogers J, Bucci LM, Mousmanis P, Lang E, Halperin S, Bowles S, Halpert C, Ipp M, Rieder MJ, Robson K, Uleryk E, Votta Bleeker E, Dubey V, Hanrahan A, Lockett D, Scott J. Exposure-based interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research. Cogn Behav Ther. 2016; 45(3):217-235.
2. Duncanson E, Le Leu RK, Shanahan L, Macauley L, Bennett PN, Weichula R, McDonald S, Burke ALJ, Collins KL, Chur-Hansen A, Jesudason S. The prevalence and evidence-based management of needle fear in adults with chronic disease: a scoping review. PLoS One. 2021; 16(6):e0253048. 
3. McLenon J, Rogers MAM. The fear of needles: a systematic review and meta-analysis. J Adv Nurs. 2019; 75(1):30-42.
4. Orenius T, LicPsych, Säilä H, Mikola K, Ristolainen L. Fear of injections and needle phobia among children and adolescents: an overview of psychological, behavioural, and contextual factors. SAGE Open Nurs. 2018; 4:2377960818759442.
5. Sørensen K, Skirbekk H, Kvarstein G, Wøien H. Children’s fear of needle injections: a qualitative study of training sessions for children with rheumatic diseases before home administration. Pediatr Rheumatol Online J. 2020; 18(1):13. 
6. Taddio A, McMurtry CM, Shah V, Riddell RP, Chambers CT, Noel M, MacDonald NE, Rogers J, Bucci LM, Mousmanis P, Lang E, Halperin SA, Bowles S, Halpert C, Ipp M, Asmundson GJG, Rieder MJ, Robson K, Uleryk E, Antony MM, Dubey V, Hanrahan A, Lockett D, Scott J, Bleeker EV, HELPinKids&Adults. Reducing pain during vaccine injections: clinical practice guideline. CMAJ. 2015; 187(13):975-982. 
7. Taddio A, Ipp M, Thivakaran S, Jamal A, Parikh C, Smart S, Katz J. Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine. 2012; 30(32): 4807-4812.
8. Tadicherla S, Berman B. Percutaneous dermal drug delivery for local pain control. Ther Clin Risk Manag. 2006; 2(1):99-113.
9. Ego Pharmaceuticals Pty Ltd. Numit [Internet]. Available from: https://www.numit.com.au/. (Accessed: 05 March 2022).