This won't hurt a bit - yeah, right...

Ouch. I had my flu shot yesterday. Our pediatrician offers them to the families, including adults. This is good for us considering only one of the family is still under 18 and under his care. It’s always hard to tell if the injection will leave a sore arm or not. Some years, I barely feel it, other years, it’s like I got a – well – a needle stabbed into my arm.

When I had the series of 3 injections (spread over a few months) for the hepatitis vaccine they give healthcare workers, I barely felt the first one, the second one hurt like the dickens, and the third was felt, but it wasn’t terrible. The same person gave all three injections.

When I gave my first injection to a patient, it was to a mentally handicapped girl at the Children’s hospital, where I was doing my pediatric rotation. The way my instructor watched me made me even more nervous than I already was and I had a really hard time doing it. I am sure I wasn’t too delicate and it’s funny, all these years later, I still feel badly about it; it must have hurt.

So, why is it that some injections hurt and some you barely feel? It’s a combination of technique, experience, the type of injection, and the serum being injected.

There are three types of injections, two of which most of us come across. The subcutaneous (s/c) injection is one that goes just under the skin. When the medication is injected into this tissue, it has a slower release into the body than if it is given directly into the muscle. The most common medication given this way is insulin. The needle used is very tiny and short. S/C injections are usually given in the upper arm, but can be also given in the abdomen (heparin is usually given this way), and the thigh. Usually, you should pinch the skin to make a bit of a tent and inject the medication into the skin, usually, at a 90 degree angle. This reduces the chances of the needle reaching the muscle. Because the needle is so thin and doesn’t reach the muscle, the injections are usually rather painless.

The other injection that most people are familiar with is the intramuscular (IM) injection. Those are the ones with the longer needles that go directly into the muscle, such as the vaccines and antibiotics, for example. These are most commonly given in the buttock if it’s a pain killer or antibiotic, the outer upper quarter in order to avoid hitting a nerve. For vaccines, it’s usually given in upper arm. For babies, it’s usually given in the thigh. Unlike S/C injections, the skin remains flat. The needle also goes in at a 90 degree angle.

Intravenous (IV) medications, medication injected directly into the vein, are usually only given as part of an IV infusion of fluids, although they can be given directly, usually in an emergency situation. Medications given by IV act very quickly.

Some medications don't sting or burn, while others can be painful. The tetanus vaccine, for example, is known for being uncomfortable. Some antibiotics can be painful too.

Very few people like getting injections, but they are a necessary part of life these days. But, with the on-going research, one day, they may not be standard any more. Wouldn’t that be nice?

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