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Easing the Pain of Injections for Juvenile Arthritis

Getting a shot can be difficult for kids and parents, but these tips can help make it easier.

By Jennifer Davis

Kids hate shots, but when it comes to managing juvenile arthritis, sometimes injections are necessary. Biologic injections can sting more than others, making shot time even more dreaded. Fortunately, drug makers are taking steps to minimize the pain of these treatments, but there are things you can do to take the sting out of shot day.

 

Why injections are painful

 

Thicker medications and ones made with certain preservatives can make shots sting even more, says Cara M. Hoffart, DO, a pediatric rheumatologist at Children’s Mercy in Kansas City, MO.

 

“Getting an injection is hard enough. But if you have a medication that causes burning at the injection site or as it’s going in, that can make injections traumatic for patients,” says Hoffart.

 

Hoffart knows what that pain is like because she gets biologic injections to manage her own ankylosing spondylitis. She admits that painful shots have made her think about trying other medications.

 

“Not only is it a bad experience for the patient and their family but [pain] can also really affect compliance,” she says. “And if you aren’t treating the disease, there will be long-term effects.”

 

What are drug makers doing

 

Several drug makers are taking steps aimed at reducing the pain of injections.

 

A new citrate-free version of adalimumab (Humira) removes the buffers that were associated with what many say was a notoriously painful injection. The new version also uses a thinner needle and injects 50% less liquid, both of which are associated with less pain.  

 

Across the patients I have changed to the citrate free version, the feedback is very positive. I have some patients who say they don’t feel the medication at all,” Hoffart says.

 

Etanercept (Enbrel Mini) also has a new phosphate-free drug formulation that Amgen says shows a significant reduction in injection site pain. The device also has an injection speed switch so people can see which speed is most comfortable for them.

 

The makers of tocilizumab (Actemra) say their product doesn’t include sodium citrate which they say can cause pain in some patients.

 

What can you do

There are many things you can do to help reduce pain during injections for your child.

 

  • Apply ice or gel packs before and after. Just don’t apply directly on the skin, which can cause a frostbite-like burn.
  • Let the injectable medicine get to room temperature for about 30 minutes before using. This can reduce the sting. FYI – it’s not safe to warm it up any other way (no microwaving!)
  • Make sure the alcohol you use to clean the injection site dries completely.  Piercing skin through wet alcohol can really burn.
  • Use an over-the-counter numbing cream that’s 2.5% lidocaine and 2.5% prilocaine. Apply a thick layer to the area about an hour before the injection. Seal the cream with plastic food wrap to keep the area airtight and then wipe it off before the shot.
  • Allow your child to select when and where the shot is given and where it goes. This gives your child a sense of control over the situation, which can reduce anxiety.
  • Choose a distraction activity, like blowing bubbles or watching TV. Victoria Ruffing, a registered nurse and director of patient education at the Johns Hopkins Arthritis Center, says she finds it helpful to have children take a deep breath and give them the injection on the exhale. “They are thinking about exhaling and not tensing up,” she explains.
  • Use an auto-injector pen to hide the sharp point of the needle.
  • Make sure you’re using the correct technique and getting the injection where it’s meant to go – between the skin and muscle rather than directly into muscle.
  • Ask the doctor about new places to administer the injection. Some people find less discomfort in the stomach but make sure it’s a safe place free of big veins.
  • If you’re nervous, it’s likely your child will be too. Ask your child’s doctor about training for parents, including videos and opportunities to practice. Until you get the hang out it, you can rely on a nearby medical clinic to give your child the shot for a fee or ask a family member or friend for help.

 

If your child’s fear is extreme, you may need to take additional steps to get her used to the idea and go through slowly. Ask your child to sit with the syringe, then later ask her to hold it. Eventually, add the needle. As your child becomes used to the equipment, hopefully, her needle fears will lessen too.

 

Devices that use a combination of cold and vibration to minimize pain can offer children some relief. A small reward like a sticker or extra screen-time for bravery can work wonders for young kids too. “You want the child to buy into what is being done and if a reward works than it works,” Ruffing says.

 

 

 

 

 

 

 

 

 

 

 

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Easing the Pain of Injections for Juvenile Arthritis

Getting a shot can be difficult for kids and parents, but these tips can help make it easier.

By Jennifer Davis


Kids hate shots, but when it comes to managing juvenile arthritis, sometimes injections are necessary. Biologic injections can sting more than others, making shot time even more dreaded. Fortunately, drug makers are taking steps to minimize the pain of these treatments, but there are things you can do to take the sting out of shot day.

 

Why injections are painful

 

Thicker medications and ones made with certain preservatives can make shots sting even more, says Cara M. Hoffart, DO, a pediatric rheumatologist at Children’s Mercy in Kansas City, MO.

 

“Getting an injection is hard enough. But if you have a medication that causes burning at the injection site or as it’s going in, that can make injections traumatic for patients,” says Hoffart.

 

Hoffart knows what that pain is like because she gets biologic injections to manage her own ankylosing spondylitis. She admits that painful shots have made her think about trying other medications.

 

“Not only is it a bad experience for the patient and their family but [pain] can also really affect compliance,” she says. “And if you aren’t treating the disease, there will be long-term effects.”

 

What are drug makers doing

 

Several drug makers are taking steps aimed at reducing the pain of injections.

 

A new citrate-free version of adalimumab (Humira) removes the buffers that were associated with what many say was a notoriously painful injection. The new version also uses a thinner needle and injects 50% less liquid, both of which are associated with less pain.  

 

Across the patients I have changed to the citrate free version, the feedback is very positive. I have some patients who say they don’t feel the medication at all,” Hoffart says.

 

Etanercept (Enbrel Mini) also has a new phosphate-free drug formulation that Amgen says shows a significant reduction in injection site pain. The device also has an injection speed switch so people can see which speed is most comfortable for them.

 

The makers of tocilizumab (Actemra) say their product doesn’t include sodium citrate which they say can cause pain in some patients.

 

What can you do

There are many things you can do to help reduce pain during injections for your child.

 

  • Apply ice or gel packs before and after. Just don’t apply directly on the skin, which can cause a frostbite-like burn.
  • Let the injectable medicine get to room temperature for about 30 minutes before using. This can reduce the sting. FYI – it’s not safe to warm it up any other way (no microwaving!)
  • Make sure the alcohol you use to clean the injection site dries completely.  Piercing skin through wet alcohol can really burn.
  • Use an over-the-counter numbing cream that’s 2.5% lidocaine and 2.5% prilocaine. Apply a thick layer to the area about an hour before the injection. Seal the cream with plastic food wrap to keep the area airtight and then wipe it off before the shot.
  • Allow your child to select when and where the shot is given and where it goes. This gives your child a sense of control over the situation, which can reduce anxiety.
  • Choose a distraction activity, like blowing bubbles or watching TV. Victoria Ruffing, a registered nurse and director of patient education at the Johns Hopkins Arthritis Center, says she finds it helpful to have children take a deep breath and give them the injection on the exhale. “They are thinking about exhaling and not tensing up,” she explains.
  • Use an auto-injector pen to hide the sharp point of the needle.
  • Make sure you’re using the correct technique and getting the injection where it’s meant to go – between the skin and muscle rather than directly into muscle.
  • Ask the doctor about new places to administer the injection. Some people find less discomfort in the stomach but make sure it’s a safe place free of big veins.
  • If you’re nervous, it’s likely your child will be too. Ask your child’s doctor about training for parents, including videos and opportunities to practice. Until you get the hang out it, you can rely on a nearby medical clinic to give your child the shot for a fee or ask a family member or friend for help.

 

If your child’s fear is extreme, you may need to take additional steps to get her used to the idea and go through slowly. Ask your child to sit with the syringe, then later ask her to hold it. Eventually, add the needle. As your child becomes used to the equipment, hopefully, her needle fears will lessen too.

 

Devices that use a combination of cold and vibration to minimize pain can offer children some relief. A small reward like a sticker or extra screen-time for bravery can work wonders for young kids too. “You want the child to buy into what is being done and if a reward works than it works,” Ruffing says.