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Comfort During Medical Procedures by Dr. Michael McKelvey

For many people, both adults and children, the idea of going to the doctor provokes immediate anxiety.  Since the earliest times, medical care has been synonymous with pain, and many people have a visceral reaction to the idea of any medical procedure or of even seeing a medical professional. Yet modern medicine has made leaps and bounds forward in the ability to control pain and anxiety associated with medical care. Modern surgical anesthesia has allowed complete comfort for those undergoing surgery, compared to the days when patients literally had to “bite the bullet.” Local anesthesia has given us the ability to perform pain-free procedures in the office setting. Yet anxiety for seeing the doctor still runs high. Trypanophobia – a fear of needles – cripples approximately 20% of the population. The modern dermatology practice has many options available, allowing for every patient undergoing a procedure to have a comfortable and non-anxiety inducing experience.

Buffered Lidocaine

Much of the discomfort of numbing injections comes from the burning experienced due to lidocaine being stored as an acid to promote shelf life and stability. By adding sodium bicarbonate to the lidocaine before injecting, nearly all the burning of a numbing injection can be eliminated.

Ethyl Chloride Spray

This “numbing spray” is a vapocoolent (skin refrigerant). The immediate cooling effects on the skin temporarily prevent the nerves from transmitting pain signals, and can make the experience of a needle stick nearly undetectable. Similar effects can be seen with icing the skin or applying a vibration device to the skin.


Witty banter from your healthcare provider can distract the brain from recognizing painful stimuli 🙂

Topical Anesthetic Creams

Topical mixtures of lidocaine, betacaine, and tetracaine can provide effective prevention of pain for superficial skin procedures such as lasers and microneedling. Because they only penetrate the skin superficially, they are not effective for injections or surgical procedures.  They also must be applied at for at least an hour for full effectiveness, and there are limits to how much you can safely apply in one session.

Systemic Medications

Although not commonly used in dermatology, anti-anxiety pills in the benzodiazepine family (Vallium, Ativan) can be used to calm patients with high anxiety about a medical procedure. These medications do not, however, provide pain relief, but only reduce anxiety. Because their effects can last hours, they necessitate the patient have a driver available to return home.

Nitrous Oxide

A pain relief option that has been around for decades but rarely taken advantage of, especially given its safety and effectiveness at reducing pain and anxiety, is nitrous oxide, more commonly known as “Laughing Gas.” Modern nitrous oxide delivery systems give the patient control over their pain and anxiety by allowing for self-administration of the gas as needed through a mouthpiece, under full control of the patient. The onset of relief is within seconds. Once the procedure is complete, the effects wear off within minutes; patients can even drive themselves home. Nitrous oxide has very few side effects, the most common being nausea, which resolves immediately after stopping the gas. Dentists have been safely using this technology for decades, and it is just now making its way to physician offices.  It can be utilized during virtually any in-office procedure, including biopsies, excisions, laser treatments, CoolSculpting, microneeding, chemical peels, and miraDry, to name a few.



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