What works best for anxiety plus medical procedure?
July 14, 2021 2:15 PM   Subscribe

I have to have an unpleasant medical procedure done. I have terrible anxiety with regard to this kind of invasive procedure. General anesthetic also worries me for health reasons. What are the best treatments for medical procedure related anxiety - what has worked for you?

I need to have an unpleasant painful gynaecological procedure. Gynaecology freaks me out. For health reasons I'd rather avoid a general anaesthetic, what is the best approach? Valium, beta blockers, sedation, gas and air, other? If you have near phobic fear of gynae procedures or similar, what has worked for you?
posted by Flitcraft to Health & Fitness (18 answers total) 4 users marked this as a favorite
In my experience anxiety caused by pain & fear of pain can only be managed by knocking out the pain. There's no way to convince my subconscious that some kinds of pain are OK the way my conscious mind understands it. If you can get IV sedation that's the best thing to do in my experience. There is no reason to torture yourself just to get healthcare.
posted by bleep at 2:20 PM on July 14, 2021

Valium worked well for dental anxiety for me. I could tell they were doing stuff (putting in an implant) but I didn't care.
posted by kbuxton at 2:28 PM on July 14, 2021 [3 favorites]

I once had that sort of procedure done under twilight sedation. Afterward I found it creepy to realize that I had apparently been conscious enough to cooperate with things like moving to a different table, but have zero memory of it. The next time I needed such a procedure, I took an anti-anxiety med that was offered (which I'd coincidentally tried before) but refused anything that would affect memory.
posted by teremala at 2:32 PM on July 14, 2021 [1 favorite]

Nitrous oxide can be pretty amazing for this in my experience, but yes, you’ll also need adequate pain relief.
posted by blue suede stockings at 2:36 PM on July 14, 2021 [1 favorite]

Response by poster: This is something else that's a problem - it's like UK gynaecologists think ibuprofen is sufficient pain relief for their procedures. They don't seem to offer much more (apart from local anaesthetic injections into invasive places which sound as bad as the procedures) is this the case elsewhere?
posted by Flitcraft at 2:42 PM on July 14, 2021

From the stories I've heard around the internet & my personal experience most providers think ibuprofen is adequate pain relief for literally anything (even though it only works on headaches and only after about 20 minutes of suffering) however if you ask they might be able to do better it's just that no one knows to ask beforehand. Ask them for the best they can do is my advice.
posted by bleep at 2:45 PM on July 14, 2021

Talk to the anesthesiologist, mention your extreme anxiety and fear.

Last three procedures I've had done (colonoscopy, minor chest surgery, and cataract surgeries) were all made SO MUCH BETTER by a very low dose of fentanyl-- I was conscious during all of them (except the chest surgery) and also the time went by very quickly and without any anxiety or discomfort.

I am a Generalized Anxiety Sufferer all my life, and I think I know exactly what kind of apprehension you have. This stuff helped so much I still can't believe it.

If this is a procedure where there is an anesthesiologist or anesthesia nurse then bring it up with them. If it isn't then talk to the medical professional before-hand and see if you can come to the procedure suitably fortified with some prescription drug or non-prescription solution. I don't know the UK guidance on medical cannabis but here in the US that would be one of my first go-to candidates.

As for the anxiety leading up to the procedure, talk to a therapist if you have one. That will also help, in my experience.
posted by seasparrow at 2:49 PM on July 14, 2021 [1 favorite]

I’ve only used it for dental procedures, but Halcion is my wonder drug. Needs to be prescribed by a doc. Same family as Xanax, you take it a half hour before the procedure. Someone needs to drive you to your appointment. During the procedure you would still get any local anesthetic or pain killers you would normally get. But during the whole thing you really do not have any anxiety or cares in the world. Its like anxiety just doesn't exist. I almost fell alseep while having 2 teeth extracted. You will need someone to drive you home, then sleep it off for another couple hours. It also has a bonus amnesia effect so even if the procedure was unpleasant, you wont remember much anyway after the fact.
posted by cgg at 2:51 PM on July 14, 2021 [1 favorite]

From my experience with these kinds of procedures in the UK: depending on what it is and where you're getting it done (hospital vs. GP surgery), they might offer you some form of pain relief, but your best bet would be to take something beforehand.

What I would do is talk to your GP if you can, describe the problem, and see if they can give you a prescription for some Diazepam to keep you calm during the procedure (if they think it's appropriate/safe). When I had my IUS installed, I took 400mg ibuprofen half an hour beforehand (this is actually recommended by the NHS to reduce cramps after the procedure). I do believe it helped.

On the day, mention your phobia/anxiety to the nurse or doctor performing the procedure, they may be able to give you something as well, or at least may be able to take steps to help keep you calm and relaxed. You are definitely not the only person they will have seen with this issue and they will likely have things they can do already in place.
posted by fight or flight at 2:53 PM on July 14, 2021 [1 favorite]

I would also ask about having someone with you. I had to have an HSG procedure and have high anxiety. They let my partner come in, hold my hand tightly and they were able to distract me, comfort me while it happened. It helped a LOT. I would encourage you to ask about this IN ADDITION to any medications which can help with the pain or anxiety.
posted by Sweetchrysanthemum at 2:55 PM on July 14, 2021

I'm in the US. A friend of mine has a terrible needle phobia, so bad that it's noted in their medical chart and they walked out of a medical facility rather than face a needed blood draw, and they avoided vaccinations too. They finally talked to their doctor about options, and the doctor prescribed one Xanax (Alprazolam, a benzodiazepine) for an upcoming blood draw. My friend said it worked incredibly well. They said, "So this is what it's like not to be terrified." They got another Xanax via prescription one a year later for another procedure involving a needle. They were cognizant the whole time.

I don't know procedures around this medication in the UK, but could you message or call your doctor's office and ask about various options?
posted by bluedaisy at 3:04 PM on July 14, 2021

A few years ago, I had to have a uterine biopsy done. They tried to do it in the office, but I freaked. I have a history of sexual abuse. Part of the problem is that she wanted to do it during the first office visit. When I was unable to complete the procedure, it got scheduled to be done at the hospital under sedation. I don't know what drugs they gave, but I don't remember any of it. Any similar procedures will be done at the hospital under sedation. The original try at the biopsy sparked a pretty big PTSD spike.
posted by kathrynm at 3:09 PM on July 14, 2021 [1 favorite]

This is something else that's a problem - it's like UK gynaecologists think ibuprofen is sufficient pain relief for their procedures. They don't seem to offer much more (apart from local anaesthetic injections into invasive places which sound as bad as the procedures) is this the case elsewhere?

This is also the case in the US. I ended up with a surprise endometrial biopsy at an appointment once, which would have gone much better with literally any kind of pain relief before/after or, honestly, mental preparation or coaching beyond “hey, hold still for a bit” as well. Many US doctors do not offer even a local for uncomfortable procedures. It’s nuts and counterproductive in that some women will then avoid care after painful experiences (care that is often being provided as follow up to cancer and cancer-adjacent stuff, so it’s important! I am glad that you are getting care even though it is tough and you are anxious!).

I have high medical/dental anxiety and after some bad experiences have learned to be very explicit about that. If I know I have a visit with non-routine stuff scheduled a Xanax prescribed beforehand or nitrous oxide during helps me a lot.
posted by charmedimsure at 4:27 PM on July 14, 2021

We're similar in this respect, and for a recent endometrial biopsy I was given liquid midazolam about 20 minutes before the in-office procedure. Tasted like cherry cough syrup. The mild sedative meant that I needed someone to drive me home afterward; that friend was able stay with me during the appointment, another help. Lastly, it helped a lot that the doctor was willing to talk with me during a consultation about my options in light of previous trauma in medical and other situations, and she was skilled and fast on procedure day. Best wishes.
posted by Iris Gambol at 4:41 PM on July 14, 2021

Depending where you are in the UK, Tylenol with codeine may be available over the counter. It was a few years ago in England. So that might help just the pain management standpoint.
posted by crunchy potato at 4:48 PM on July 14, 2021

A combination of fentanyl and versed is common for colonoscopies here in the US. Or propofol. .
Both of these require specialized staffing and equipment, however.

I had IV Valium (with Novocain) for my wisdom teeth extractions. That taught me the meaning of “controlled drug.” They could have done anything and I wouldn’t have cared. But it was pretty painless because of the mooching. I do t know how it would have felt on just the Valium.

Ativan is often prescribed foe Pre procedure anxiety here, also.
posted by SLC Mom at 4:59 PM on July 14, 2021

I think I can guess what procedure you're about to have, and I am so sorry you have to have it. I've had it 3 times now and I refuse to do it again.

The first two times, I was also told to just take ibuprofen. I am still mad about it. I needed both Ativan and a strong pain med (don't remember what it was, but man, did I feel better). I got the right combo the third time by saying I was on the verge of a panic attack and that I would be spending the next few hours vomiting after the procedure if I didn't get something to smooth things through.

This is a lousy description of what helped. Mostly I just want you to know that this internet stranger will be thinking of you and sending vibes for a pain and anxiety free procedure.
posted by Hermione Granger at 12:24 AM on July 15, 2021 [1 favorite]

Response by poster: Thanks, these are all very helpful. I've spoken to the consultant about it and she has suggested I see my GP to get something prescribed for anxiety for the procedure, but I'm amazed by the way gynaecologists aren't set up for this. Proper pain relief and medication available for anxiety should be routinely available not something you have to go and make a fuss about.
posted by Flitcraft at 1:00 PM on July 15, 2021 [1 favorite]

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