Tips to Reduce the Pain of Injectionsby Lisa Emrich Patient Advocate
Several of the medications used to treat multiple sclerosis (MS) are injectable drugs. The requirements for storage and administration differ for each drug, but here are some universal tips that will help reduce the pain of the injections. Please note that if you have questions or difficulties with a specific drug, call the drug company’s helpline or ask your own MS nurse for help.
Bring medication to room temperature first
Medications that must be kept in the refrigerator for storage are often much less painful upon injection when brought up to room temperature. Before injecting, remove one pre-filled syringe from the refrigerator and leave the syringe out for at least 30 minutes before using. Or alternatively, while still in the wrapper, hold the syringe in your armpit to bring it to body temperature more quickly.
Inject medication after a warm shower
Cold skin can be hard and stiff. Inject after a warm shower, when the skin is soft and supple. Or apply a warm compress to the injection site for five minutes before injecting. However, take caution in any area where sensation of temperature is impaired to avoid burning yourself.
Prevent irritation by keeping injection site clean and dry
Wet alcohol on the skin can burn during injections. If you use an alcohol swab to clean the skin, let the alcohol dry before injection to avoid the sting. Then after the injection, quickly apply a cotton ball to prevent medication from potentially leaking and irritating the surrounding skin.
Decide which is best: manual injection or auto-injector device?
Each of the self-injectable MS drugs can be delivered by manual injection or by use of an auto-injector device. With manual injection, you have complete control over depth of needle insertion and speed of injection. With an auto-injector, the device “hides” the needle and pushes the plunger for you. One complaint with auto-injectors stems from the sudden, loud snap of the spring-loaded trigger that can startle some people.
Research single-use and multi-use auto-injector devices
Each of the following types of devices are available for use with MS disease-modifying medications.
- Single-use device: Avonex, Plegridy, Rebif
- Multi-use spring-loaded device with injection depth adjustment: Copaxone, Glatiramer Acetate, Glatopa, Extavia, Rebif
- Electronic multi-use device with speed and depth adjustments: Betaseron
- Electronic devices not yet FDA approved for use in the U.S.: Rebif, Extavia
How to set auto-injector depth
Everybody is different. Depending upon how much extra cushion (i.e., fat) or lack thereof you have, set your auto-injector depth accordingly. Deeper is usually better, but not so deep as to risk hitting a muscle — ouch! Adjust the depth somewhat for each injection site location. More fat equals greater depth; higher number. Less fat equals less depth; lower number. Do not touch the trigger until you are ready to inject!
Keep skin intact by rotating injection sites
Help keep your skin healthy! Rotate injection sites, moving between different areas of the arms, legs, abdomen, buttocks, or other approved areas. Do not inject in the same place twice in a row and be sure to wait at least seven days before using a particular spot again. Do not inject into skin that is irritated, reddened, bruised, infected, or scarred in any way.
Massage the injection site
Post-injection, gently massage the area. For different forms of beta-interferon, you may do this immediately. For glatiramer acetate, it is recommended to wait at least 24 hours before massaging any lumps that may develop. If you are unsure about whether you should massage the injection site, talk to your neurologist.
Always ask for help if you don’t know how to inject your medication
Anytime you have difficulty with injections, do not hesitate to talk to your doctor, an MS nurse, or an expert from the appropriate pharmaceutical company. These professionals are there to help you. And keep in mind that as drug companies improve auto-injector technology, injection tips may change.