Reducing the Pain of Injections at the point of Administration. 

There are a number of factors that cause pain at the point of IM Injection Administration

To minimize post-injection pain, several important factors need to first be considered

  • Needle condition, length, gauge
  • Volume of Injection
  • Injection Site
  • Injection technique, including speed of injection
  • The chemical composition of the drug/solution being used
  • Massage and manual pressure

The Needle.

As we discussed in the first Chapter you should always use two needles for each injection. 

One to draw up the compound into the syringe and another for the actual Injection. 

This is to preserve the sharpness of the needle.  A sharp needle is clearly going cause less trauma to the Muscle Tisse it enters than one blunted to any degree however minimal. 

The volume of Injection 

Correct volume (no more than 3 mL at a site for any IM in Humans). 

The volume of injection can contribute to post-injection pain. Smaller, more frequent injections are likely to cause less pain than larger injections administered bi-weekly (or every few months in the case of long acting T. preparations like Nebido.)


Injection Site and Technique 

See the first Chapter for a review of correct site selection. 

How to reduce pain caused by Injection technique

See the first Chapter for a review of correct Injection technique 

Rotate injection site to prevent indurations or abscesses, site reactions and the formation of scar tissue.

Give an injection site a week or two off before injecting there again. This helps to limit injection site reactions and the formation of scar tissue.

It has been found that necrosis of the muscle will occur after any IM injection no matter what medication is injected. The only variable is the size of the necrotic lesion and the severity of it. Forceful placement of a volume of fluid into a closed space will cause damage. In other words, the surrounding muscle and tissues in the immediate area of the needle tip are subjected to the pressure of the mass of fluid that has been instilled into the area, which causes pressure necrosis. The toxicity of the medication, the volume injected, and even the speed at which the injection is given also will influence the size of the necrotic lesion. (Treadwell, 2003)

Katsma and Smith (1997) suggested that the potential for pain with IM injections is due to the kinematics of injections ( the movement of the needle through muscle and tissue) and concluded that, “minimizing of this effect is accomplished by controlling the needle trajectory during penetration along a linear path from point of contact to end point.” 

In other words, the needle should go straight in, with no deviations in its path.

Hold the syringe steady during the procedure to prevent tissue damage

Traditionally nurses have been taught to leave a few millimeters between the skin and the hub of the needle in case the needle breaks off during the injection. This practice is not evidence-based and with modern single-use needles, is no longer necessary. 

Speed of Injection

Inject medication slowly but smoothly. 

Depress the plunger slowly at a rate of 1ml every 10 seconds; this aids absorption of the drug and reduces pain.

When all the drug has been delivered in depot wait for 10 seconds to allow the drug to diffuse into the tissue and then quickly withdraw the needle.

The chemical composition of the drug/solution.

1, Solvent concentration of Substance

2, Concentration of Active Product

Higher dosage concentrations will require higher solvent concentrations.

The concentration and type of solvents used in the preparation of the substance to be injected will affect any pain and soreness that will be experienced post-injection. 

A common solvent used as a preservative in anabolic steroid and other IM injection preparations, is benzyl alcohol and yes at high concentrations, benzyl alcohol will cause point of injection pain in the vast majority of users, however in concentrations <10% benzyl alcohol most will experience little discomfort due to BA. 

The concentration of the Active Product

This is probably the most prevalent cause of post-injection pain by highly experienced anabolic steroid users. 

This is most likely due to the demand for underground laboratories to produce more concentrated steroid preparations (high mg/ml of hormone) to reduce number and volumes of injections.

By way of example

Do you know why Testosterone Proprionate Injections are so painful, even if done “correctly” ? 

If we look at the preparation of Testosterone Propionate by legitimate pharmaceutical companies, we see that the maximum concentration normally produced is 50mg/ml.
 
The Testolic Product show below is 50mg/ml ( 100mg/ 2ml ) this is done for a reason ! 

AAS Hormones that are partnered with short esters – Acetate, Propionate etc have a much higher melting point that those that have with medium length esters – Enanthate, Cypionate, or longer Esters Decanoate, etc and thus are more difficult to make as concentrated. 
 
Although Testosterone Propionate can easily be made at 100mg/ml without crashing out of solution, it does take ” more Solvent” to do so.. 
 
The consequence of that action is that once injected, the higher level solvents tend to leach out of the solution faster than we want, at least faster than the Carrier Oil can leave the site of administration.  
 
and this means we are left with higher levels of oil and hormone in the muscle than ideal without the solvents required to suspend them and so some of the hormones crashes out of solution creating “crystals” 
 
These are the same crystals you will see in a vial where the Hormone has come out of suspension – see image below.  Note the Test Prop in the image was 200mg/ml – no wonder it crashed.

 

 
These crystals are what causes the pain. 
 
Unfortunately for us the process will also involve inflammation of the area and the inflammation prolongs the entire process of ” recovery” this is why it can take several days to fully recover from a Test P shot that ” crashes on you” 
 
What was the maximum concentration of Testosterone Proprionate typically produced by Licensed Pharamceutical Companies ? 
 
50mg/ml 
 
And your Test Prop that is causing pain ? 
 
100mg/ml, 200mg/ml ? 
 
There is a “reason” that you will find much higher concentrations of Hormone per ml from UGLs than from Licensed Pharmaceutical Manufacturers. 
 
This is it. 
 
Takeaway ? 
 
If once you have “mastered the art of administration” you are still experiencing Pain on admin,  the only real factor left is to lower the concentration per mg 
 
The maximum normal concentration that can be achieved before pain is experienced is what Pharmagrade Manufacturers supply 
 
Testosterone Propionate less than 100 mg/ml
Testosterone Enanthate less than 250 mg/ml
Testosterone Cypionate less than 250 mg/ml
Nandrolone Decanoate  less than 250 mg/ml
Nandrolone Phenylpropionate less than 150 mg/ml
Trenbolone Acetate less than 100 mg/ml
Trenbolone Enanthate less than 250 mg/ml
Methenolone Enanthate ( Primobolan ) less than 100 mg/ml
Drostanolone Propionate ( Masteron ) less than 150 mg/ml

Despite this, most underground labs today will produce multi-use vials of testosterone propionate that are at a minimum of 100mg/ml. 

” Virgin Muscle” Soreness 

When a new administration site is used for the first time users can experience what is commonly referred to as ” virgin muscle soreness”  

The cause of this is quite straight forward the muscle group is not used to containing an additional volume of a substance, and as a result some degree of pain can present 

This is usually only experienced when a site is first used for an IM injection and the solution quite simple, to initially inject a small volume perhaps as low as 1/2ml for the first couple of shots at that site 

Massage 

To massage or not to massage ? 

Current best practice advises against massing the area following administration. 

 

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