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
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 percent 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 Propionate Injections are so painful, even if done “correctly” ?
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.
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
To massage or not to massage ?
Current best practice advises against massing the area following administration.