Original Author- JOSHUA RIVERDALE JANUARY 10, 2016
While intramuscular administration of Testosterone has been shown to be a very effective delivery method, research suggests that 40% of those who received Iner Muscular injections described it as very painful!
Are there ways to reduce the pain associated with Iner Muscular Testosterone injections?*A Google search or Facebook post will yield all kinds of conflicting information. This review of Scientific Studies sets the record straight on minimizing post-injection pain from Iner Muscular injections!
To minimize post-injection pain, several important factors need to first be considered:
Needle length, gauge, and “switching up”
Volume of injection
Injection technique, including speed of injection
Massage and manual pressure
With Iner Muscular injections, Testosterone is deposited DEEPLY! into vascular muscle tissue. The deltoid (arm), vastus lateralis (thigh), and gluteal muscles (hip/buttocks) are*the most common sites for Iner Muscular injections.
Some injection sites are more prone to pain than others. Areas of the body with less subcutaneous fat are generally less painful injection sites.
The ventrogluteal site has less subcutaneous tissue and a thicker muscle mass than the dorsogluteal site. Therefore, the needle has a better chance of reaching the muscular tissue in the ventrogluteal area than in the dorsogluteal area.Remember the Artical I did on Ventrogluteal injections??? In various studies it was found that most injections given to the dorsogluteal site delivered medication into the FATTY TISSUE. “Pain receptors are found within the subcutaneous layer, not in muscle tissues and so injections administered into subcutaneous tissue may be more painful” So in other words it is imparative that you use a Needle that is of proper length! *For instance for my Ventrogluteal Injections I was using a 25 gauge, 5/8 inch… and there were times it was sore as fuck the next day! Now I use a 1 inch in the lower Ventro, and a 1.5 inch in my upper Ventro and now none to very min PIP!!
Rotating injection sites is a MUST!!! Give an injection site a week to 10 days 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 Iner Muscular 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 (Testosterone)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( meaning how fast you push the Fluid, Testosterone through the syringe)also will influence the size of the Necrotic lesion.(Treadwell, 2003)
Definition of Necrotic ~ “The death of cells or tissues from severe injury or disease, especially in a localized area of the body. Causes of necrosis include inadequate blood supply (as in infarcted tissue), bacterial infection, traumatic injury, and hyperthermia.”
Needle Length, Gauge and “Switching Up”
The needle used to inject should be long enough to penetrate through the subcutaneous tissue into the muscle mass, or the patient will have more pain. (Güne?, 2013.) The typicalneedle gaugeused to inject testosterone is between 22 and 25. It would stand to reason that using a smaller gauge needle would reduce injection pain, but researchers have disagreed on this on this point. (Gill, 2007 and Flanagan, 2007.)
Just Say No to Blunts!*We should ALL be commonly advised to use one needle for drawing up, discard it, and then “switch up” to a higher gauge needle for injection. Here’s why:
It’s not hard to imagine that the duller tip of the needle would cause more pain, but again, studies have not Unanimously concluded that this is the case (Rock, 2000 and A?aç, 2011.) Also keep in Mind, and I waited a week to do this Artical so I had the Opportunity to test this myself… If your using a 23 gauge 1inch Pin, and you are still receiving pain then I highly recommend a 1.5 inch pin.
Volume of Injection
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 Ester Testosterone preparations.
Injection technique is another consideration when evaluating post-injection pain, but research in this area is also conflicting. In one study, theAir-lock (AL) injection techniquewas found to be more effective at reducing pain caused by Iner Muscular injection versus theZ-track (ZT) method(Najafidolatabad, 2010.) Earlier studies also found Air-lock was a better method for avoiding seepage of the medication, which is associated with lower absorption and pain (Quartermaine, 1995 and Mac Gabhann 1998.) On the other hand, other studies from the ’80s found the opposite to be true, that Z-track is associated withlesspost-injection pain (Keen, 1986 and Kim, 1988.)
Katsma and Smith (1997) suggested that the potential for pain with Iner Muscular injections is due to thekinematicsof 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.” Basical I’m saying , the needle should go straight in, with no deviations in its path.
Does injection speed play a role in post-injection pain?*Again, it’s hard to say: two studies concluded that injection speed was not a factor (Mitchell, 2001 and Chan, 2001) while a more recent study showed that faster injections induced less pain in babies (Lundberg, 2008.)
To Massage or Not to Massage?
There are different injection protocols for different medications, so advice you find online about this may or may not apply to your Testosterone injection. For example, with the Iner Muscular injection of vaccines, massaging the site of injection is highly discouraged as it can push the medication into the subcutaneous layer, reducing effectiveness and potentially causing irritation.
Given thatsubcutaneous administration of Testosterone has been proven effectivewhy would the migration of Testosterone into the SUBCUTANEOUS layer be problematic? Because pain receptors are in the SUBCUTANEOUS layer not in muscle tissue (Güne?, 2013.) Massaging the injection site can push the TESTOSTERONE into the subcutaneous layer where there is greater sensitivity to pain.
Discussions onnursing forums, as well as journal articles, indicate that massaging the injection site is an out-of-date technique (Beyea, 1995.) Indeed, theAustralian Immunisation Handbook( Handbook used in 90% of all Hospitals) critical nursing reference now in its 10th edition, had advised against rubbing Iner Muscular injection sites, and the recommendation to “gently apply pressure for 1 or 2 minutes” post-injection does not appear in the latest edition. 11th Edition is out now, My apologies artical is a little old. It is now highly recommended to not even apply pressure to the site at all.
“Oh people can come up with statistics to prove anything, Kent. Forty percent of all people know that.” – Homer Simpson
However, the findings of a 2001 study indicated that massagewaseffective in reducing pain perception of adult patients after the administration of an intramuscular injection.
Even with evidenced-based research, it’s hard to know what’s actually true!
What about applying pressure before an injection?*A 1996 study found that this lessened post-injection pain. Subjects in a 2002 study reported also lower pain intensity scores with manual pressure applied before injections, suggesting that this could be an effective means of decreasing post-injection pain (Chung, 2002.)
With the science out of the way, let’s get down to the practical things you can do to improve your Iner Muscular injection experience!
10 Tips to Reduce Iner Muscular Injection Pain
Find injection sites that work for you (“sweet spots”) and rotate them.The deltoid (arm), vastus lateralis (thigh), and ventrogluteal (hip/butt) muscles are acceptable sites for Iner Muscular injections. The common Dorsogluteal injection site IS NO LONGER RECOMMENDED!!. (Doing Testosterone shots in your butt)
Choose your gear wisely.*Use a needle that is long enough to penetrate deep into the muscle. Use a larger gauge needle for drawing up, then switch to a smaller gauge needle to inject.
Shorten your cycle.*If you’re injecting every 14 days, you might try moving to a 7 day cycle to see if injecting the smaller volume helps minimize pain.
Re-visit your injection technique.Air-lock or Z-track? Are you injecting straight in or does the trajectory of the needle shift during injection? Fast or slow? Small tweaks to your technique might provide big wins in reducing post-injection pain.
Warm up and relax.*Have a hot shower or bath before your injection to warm up the injection site. While injecting, keep the muscle relaxed (and unflexed.)
Warm up your T. too!*Hold the vial in a closed fist for a couple of minutes, run it under hot water or place it on a baseboard heater for a minute to warm the T. to room temperature or a little higher. Warm oil in a warm muscle will produce less pain than cold oil in a cold muscle!
After sterilizing the injection site with alcohol, let the skin dry.Penetrating the skin with the needle before the alcohol has evaporated can cause a stinging pain sensation.
Apply manual pressure to the injection site for seconds before your injection.*Be sure to maintain sterility!
9 After your injection, reduce pain and swelling by applyingtopical Arnicagel or cream, and then ice the injection site.
- Some people swear by it, so massage the site after injection if you think it helps! But keep in mind what we discussed!
Pain after an Iner Muscular Testosterone injection is very common but there are numerous things you can do to minimize and even eliminate post-injection pain. In the end, every body is different and what works for one guy, it may not work so well for another. So, knowing that Science doesn’t have all the answers yet, just do what works for YOU to maintain pain-free injections!
here are my rotations and Pin Size
Lats, 1inch lower, 1.5 upper
Rear Delts, 1in
Lateral delt, 1in
Front Delt, 1in
Ventrogluteal. 1in lower, 1.5 upper
I do not inject in Quads due to a bad Experience.
well, there you go everyone! there it is! I hope this helps or at the very least clears up any confusion. Scientifically Noted everyone
Najafidolatabad SH, Malekzadeh J, Mohebbinovbandegani Z.*Comparison of the pain severity, drug leakage and ecchymosis rates caused by the application on tramadol intramuscular injection in Z-track and Air-lock Techniques.*Invest Educ Enferm. 2010; 28(2):171-175