© 2010-2012 Jerry Emanuelson

Iontophoresis for Needle Phobia

Practical iontophoresis for needle phobic patients

This page is a supplement to the Needle Phobia Page.  If you have not read the Needle Phobia Page, please go to that page first.

Iontophoresis is a process which uses a mild electrical current to drive lidocaine into the skin so the injection or venipuncture site can be quickly anesthetized to a depth of 1 or 2 centimeters.   The process only takes about 10 minutes.  These devices are extremely important; but are, in many countries, almost impossible for individuals to obtain, therefore many people will want to return to the main Needle Phobia Page.

An FDA-approved medical device originally made by Life-Tech called the NeedleBuster® was designed for this purpose for needle phobics and was available in the past to health care professionals.   (Although a company in Quebec has a web page showing this product, it is no longer produced by Life-Tech, and does not actually seem to be available anywhere.)  A similar competing iontophoresis product was Numby Stuff® from Iomed Clinical Systems.   The complete Numby Stuff unit is not currently being sold although it looks like some replacement components and supplies can still be purchased.

A more recent iontophoresis unit was LidoSite® made by Vyteris and approved by the United States Food and Drug Administration in 2004.   The prescribing information for the LidoSite unit specified that it was to be used only in a professional health care setting.   The LidoSite unit was made for administering about half of the dose of previous lidocaine-iontophoresis units.   The LidoSite unit has not been actively marketed in a long time.   In a legal document that was filed in April 2011, the company stated,  "Our LidoSite product is currently dormant, and there are no plans to engage in further development, marketing or licensing of this product."

Iontophoresis units cost a few hundred dollars.   At one time, they could be purchased by individuals if the individual had a doctor's prescription for the device, but there have been a number of inexcusable complications to individual purchases in recent years caused by those who have no understanding of needle phobia.

A major problem with the Lidocaine-iontophoresis units was that most manufacturers of these units would only market and sell them to doctors offices and hospitals, the very people who think that such units are not needed.   Quite predictably, the result was that all of these products failed in the marketplace, and entered the vast graveyard of very effective, but abandoned, products that could have been very useful for needle phobics.

Thousands of lives could be saved every year if the makers of iontophoresis units had a rational system for making their products available to the consumers who really need them.  The current situation with the Lidocaine-specific iontophoresis units being unavailable puts many patients in a difficult position.  Some patients who would otherwise use a Lidocaine-specific iontophoresis unit may be able to use the Synera/Rapydan patch.  Hopefully, some company will fill the current void, and produce a Lidocaine-specific iontophoresis unit with a rational marketing plan.  I don't know of any such devices made specifically for needle procedures that are available at the present time.

General-purpose iontophoresis units (sold without Lidocaine) have recently been manufactured in many countries for many different uses, including the deep hydration of skin in order to prevent excessive sweating.  These general-purpose iontophoresis units and electrodes are now being sold internationally without a prescription.  Although even the general-purpose units that are made in the United States are shipped from the manufacturer with the intention (as stated in the product labeling) of being used only in a professional medical setting, some of these general-purpose units are quite often sold by medical supply companies without the necessity of a doctor's authorization.  The Lidocaine HCl solution, though, DOES require the prescription of a licensed physician in the United States.

The wider availability of general-purpose iontophoresis units in many countries may make things easier for needle phobics because, if the patient approaches a doctor with iontophoresis unit and electrodes in hand, the doctor may be much more cooperative in supplying a prescription for the Lidocaine HCl solution.  In fact, a doctor will probably have a suitable Lidocaine HCl solution right there in his office.  The solution does have to be lidocaine HCl (lidocaine hydrochloride).  Plain Lidocaine will NOT work for iontophoresis.  The solution needs to be very pure since it is going to be electrically driven underneath your skin.  Do NOT try to use any of the over-the-counter numbing gels with iontophoresis units.  The clinical iontophoresis units for needle procedures had a Lidocaine HCl solution with a very small amount of epinephrine.  The epinephrine keeps the lidocaine HCl in the local area of the body for a much longer period of time.  The epinephrine can also reduce the local skin redness and irritation that is experienced by about ten percent of the individuals using iontophoresis.  Since the Lidocaine HCl/epinephrine solution is more difficult to obtain than the Lidocaine HCl without the epinephrine, many needle phobics have been forgoing the epinephrine.  The numbing effect is typically 15 to 20 minutes without epinephrine and 60 to 90 minutes with epinephrine.  This varies with different iontophoresis settings and among different individuals.  The epinephrine causes vasoconstriction, which can make the veins more difficult to access.

Always buy the Lidocaine HCl solution from a legitimate pharmacy.  I have seen Lidocaine advertised for sale without a prescription by non-pharmacies on the internet.  Many of these companies are not even clear whether their product is Lidocaine or Lidocaine HCl.  I cannot emphasize enough the importance of getting the Lidocaine HCl from a legitimate pharmacy or directly from a doctor.  You need to know exactly what you are getting.  Although Lidocaine HCl has an excellent safety record, nothing is perfectly safe, and you certainly don't want anything of questionable purity.  A solution called Iontocaine, which was specifically designed for use prior to needle procedures, was voluntarily removed from the market by the only authorized manufacturer.  This is probably because adverse effects from Lidocaine products can occur just often enough that most manufacturers don't want to bother with what they see as a very small market for Lidocaine-iontophoresis units for needle phobics.

 

 

The remainder of this page is a web page that I wrote on the general use of iontophoresis for needle phobia.  It is presented here only for purposes of general information.  I decided to go ahead and put it on line because many people have been wanting this information.  Most people without a basic scientific understanding of iontophoresis have difficulty in using a general-purpose iontophoresis unit for a specialized purpose.   I probably won't be refining this page or adding to it any further unless new iontophoresis products come onto the market that are worthy of note.

Many needle phobics have been frightened away from iontophoresis because it is a big word, and the whole subject sounds mystifying.  Actually, once a person gets past the strange word, and gets into the instructions for using iontophoresis, it is a very simple procedure.  It is a procedure that has changed the lives of many people who suffer from needle phobia.  Nevertheless, I've been disappointed at how few people have even tried using iontophoresis.  Of the few who have tried, the failure rate for people using these general-purpose units seems to have been much higher that I would have expected.  Iontophoresis worked very easily for me, but I spent much of my childhood studying electrochemistry, so the basic principles of iontophoresis came as second nature to me.  For those who do not have this background, this rather simple process can be somewhat mystifying.  The result can be that a simple error or malfunction of the cables or equipment can result in an enormous amount of frustration.  If you are a needle phobic with a basic scientific or technical background, though, simple Lidocaine HCl iontophoresis can be a life-changing procedure.

In the past, iontophoresis units with the lidocaine-based anesthetic solution were available.  These were much easier to use for a specific purpose than the general purpose iontophoresis units.  Because of less than competent marketing, however, those special lidocaine iontophoresis units that were designed especially for use with needle procedures are no longer available.

Basically, iontophoresis is simply the use of a small DC electric current from a portable battery-operated device to drive a controlled amount of a local anesthetic deeply into the skin.  In a Lidocaine HCl solution, the Lidocaine is a positively-charged ion.  Since like charges repel, the positively-charged electrode pushes the Lidocaine deeply into the skin.

In recent years, iontophoresis has become much more widely used for a larger variety of conditions, using a variety of different medicines.  In many countries, the iontophoresis units and electrodes do not require a physician's authorization for purchase.  In the United States, although (the last time that I checked) these units still technically needed a doctor's authorization, many sellers of these units are no longer requiring a specific written physician's authorization.

Please don't ask me about whether a particular unit from a particular seller requires a doctor's written authorization.  This is a complicated issue, and I am neither a lawyer nor a doctor.  This web page is read around the world, and the regulations are different in every country.  Many people simply buy what they can without the doctor's written authorization, then obtain the Lidocaine Hydrochloride solution from directly from the physician after telling the doctor that they want to use it for the iontophoresis unit.  As explained below, there are several advantages to doing the iontophoresis procedure in the doctor's office or clinic immediately before the scheduled needle procedure.  If you do the procedure at home, the numbing effects may have worn off before you get the needle procedure done.  As I explained on the main Needle Phobia page, it is very important to obtain the Lidocaine HCl solution from a doctor or from a licensed pharmacy with a doctor's prescription.

All physicians are very familiar with Lidocaine HCl.  Most doctors are not very familiar with iontophoresis, and they are (understandably) usually very reluctant to write a prescription for devices that they know little about.  Most needle phobics will have much better success if they can bring an iontophoresis unit with a suitable electrode to the doctor's office or clinic.  Needle phobia is one of many conditions where a successful outcome requires that the patients take the lead.

If you decide to use the unit for the first time in a doctor's office or clinic, be sure to familiarize yourself with the unit as much as possible while you have it at home.  Make sure to install the batteries before taking it to a doctor's office or clinic.

 

One of the most encouraging developments in the treatment of needle phobia during the 1990s was the introduction of Lidocaine iontophoresis units.  This was a method of driving the common anesthetic called Lidocaine (in the form of Lidocaine hydrochloride) deep into the skin using a small electrical current.

Although Lidocaine iontophoresis units have remained on the market to a certain extent, they have become very difficult to obtain in recent years.  This has largely been because the manufacturers of these units have not known how to effectively market these units for needle phobia.  They have generally tried to sell the units only to the people who do not believe that needle phobia is a significant problem, and therefore do not believe that these units are needed.  To further assure the failure of those products, they have insisted upon trying to sell the products only in bulk quantities to the people who believe that these units are not needed.

The unit shown in the photo on the right is the Dynatronics Ibox, which is a general purpose iontophoresis unit.  It is not designed for any specific medicine, but it can be used with a Lidocaine HCl solution and the proper standard iontophoresis electrodes.

 

The Lidocaine hydrochloride (Lidocaine HCl) does require a physician's prescription in the United States.  This means that the iontophoresis units will be used with the effective authorization and knowledge of a physician.

Most physicians have Lidocaine HCl in their offices.  It is also available by prescription from pharmacies with a doctor's written prescription.  One of the best options for many needle phobic patients may be to bring an iontophoresis unit into the doctor's office, along with suitable electrodes, and do the Lidocaine HCl iontophoresis in the doctor's office immediately before the needle procedure.  The iontophoresis procedure only requires ten minutes, and there are several advantages to doing the iontophoresis procedure in the doctor's office or clinic.

The way that most Lidocaine HCl solutions are packaged requires a needle and syringe for removal of the solution from the vial.  Although the needle used for this never touches your body, many needle phobics will be reluctant to handle a needle and syringe even for this simple transfer of a solution.  If everything is done in a doctor's office, a nurse can handle this simple part of the procedure.  If the person who will be doing the needle procedure is directly involved with the iontophoresis procedure, then you can be more assured that the needle procedure will be done in the place that is being numbed by the Lidocaine iontophoresis.

Lidocaine HCl solution comes in several strengths (generally 1 percent, 2 percent and 4 percent).  It also comes with or without another substance called epinephrine.  All of these lidocaine HCl solutions will work for iontophoresis.  The solution that was provided with the commercial lidocaine iontophoresis units such as the Needle Buster® and Numby Stuff® was a 2 percent lidocaine HCl solution with a small amount of epinephrine.  The epinephrine contracts the blood vessels and keeps the lidocaine in the area under the electrode for a longer period of time.  The epinephrine can also help to eliminate the skin redness and other minor allergy-type reactions that may occur in the skin underneath the active electrode.

Since the Lidocaine HCl/epinephrine solution is often more difficult to obtain than the Lidocaine HCl without the epinephrine, many needle phobics have been forgoing the epinephrine.  The numbing effect is typically 15 to 20 minutes without epinephrine and 60 to 90 minutes with epinephrine.  This varies with different iontophoresis settings and among different individuals.  The most commonly-available Lidocaine HCl solutions do not contain epinephrine, but they will usually last long enough for most common needle procedures.  How long the numbing effect will last depends upon the individual.

The standard dose for Lidocaine iontophoresis is to operate the unit at 4 milliamperes (4 ma.) for 10 minutes.  This provides a standard dose of Lidocaine under the active electrode for any of the common strengths of Lidocaine HCl solution.  The iontophoresis units maintain whatever current level (in milliamperes) that you preset the unit to, and most units will automatically turn off after a preset amount of time.

Most units are very easy to set up.  If you have a "two-channel" unit, you have to make sure to plug the electrodes into the correct jack (which will usually be the channel 1 jack).  Also make sure that you set up the unit for the same channel to which the electrodes are connected.  Also, make sure that you connect the correct clip to the active electrode.  Lidocaine iontophoresis only requires one set of electrodes.  Most electrode packages contain both the active and the passive (ground) electrodes in each packet.  In most cases, the passive (ground) electrode is rectangular in shape, while the active electrode has a unique shape.  The active electrode must be placed directly over the location of the upcoming needle procedure (the area to be numbed) and the passive electrode can be attached to any convenient area of the skin nearby.  Both electrodes have an adhesive that is just strong enough to keep the electrodes in place during the iontophoresis procedure.

It is fairly common for skin redness to occur during the iontophoresis, and on rare occasions some individuals even have some mild blistering.  These superficial skin conditions rarely last for very long, and the skin will usually return to normal several minutes after the procedure is completed.

 

At the right side of this page is a photo of me using the Dynatronics Ibox iontophoresis unit on my own arm.  I am using Trivarion medium (2 cc.) iontophoresis electrodes.   The 2 cc. means that the electrodes are designed for 2 cc. of Lidocaine HCl solution to be absorbed into the active electrode.  (The electrodes do not contain lidocaine, or any other medicine, when you first take them out of the package. They have to be soaked with the appropriate amount of Lidocaine HCl solution by you, or by your medical assistant.)

In addition to setting the time (10 minutes) and the current level (4 ma.), be sure that the polarity is also set correctly.  This is fairly easy to do, since for Lidocaine HCl, the polarity setting is simply normal or + (positive).  The polarity will be preset if you are using a unit specifically designed for lidocaine iontophoresis, but on general purpose units, it can be set either positive or negative (and a few units can be set to alternating current, which you do not want when you are using Lidocaine HCl.)

 

Although I already get a very large volume of email (and I spend a lot of unpaid time answering that email), I am very interested in hearing from other people about how well these general-purpose iontophoresis units work for them.  Everyone is somewhat different in this regard.  I am interested in reading about your personal experiences in order to provide a better quality of information to other needle phobics.

 

 

The process of soaking the electrodes in the proper amount of Lidocaine HCl solution is extremely simple and quick, but many needle phobics will be uneasy about it because it usually involves using a needle and syringe for the transfer.  You can usually get a nurse to do this very simple part of the process if you are uneasy about it, especially if you plan to use the iontophoresis unit in a doctor's office anyway.  The photo at the right shows the pad that is on the bottom side of the medium-sized Trivarion iontophoresis electrode.   The circular pad is what is soaked with the Lidocaine HCl solution.   In the photo, the covering that exposes the adhesive on the bottom side of the electrode has not yet been peeled off.

 

One obvious question that many people will have is:  Why can't this iontophoresis process be used for ALL medicines that currently require a needle?  In some cases, other medicines could use iontophoresis.  Sometimes, the medicines are just not produced and distributed in a form that is compatible with iontophoresis.  In the cases of most medicines, though, iontophoresis could not be used because of the quantity of the medicine that must be administered -- or the fact that the medicine does not form electrically-charged ions when it is dissolved in water.  For now, we have to accept the fact that iontophoresis does work for Lidocaine HCl, and to let the medical industry (including the local medical professionals) know that the use of iontophoresis needs to be greatly expanded.

Many people who relied on iontophoresis units in the past may be able to use the Synera/Rapydan patch instead for many procedures.  See the main Needle Phobia Page for more information on the Synera/Rapydan patch.

This page is for informational purposes only.   It is not intended to provide any medical advice.   The Needle Phobia Page and this Iontophoresis page are both maintained by Jerry Emanuelson.

Jerry Emanuelson's email address is help@needlephobia.com