Humira injection suggestions for skinny teenagers

March 19, 2017 1:50 PM

We've been told we need to move to Humira injections for kiddo diagnosed with Chronic Recurrent Mulifocal Osteomyelitis (CRMO). Looking for any suggestions on making the injections less painful.

My son, 13-years-old, was diagnosed with CRMO last year. He has been on methotrexate (8 pills 1x a week) and Mobic but a recent MRI indicated a worsening of his condition. We are moving to Humira which we've heard is quite painful. Some suggestions to make it less painful are: (1) bringing the pen to room temperature; (2) pinching a fold of the skin; and (3) injecting the stomach versus the thigh. He is quite thin so there isn't much fat to pinch. Any other suggestions from doctors or Humira users to help with the pain of injection?

posted by youdontmakefriendswithsalad to Health & Fitness (15 answers total)

It helps to inject in the stomach, after holding an ice cube there for a minute - until the area is good and numb. Then pinch the area and let it rip. Tell him that it will always sting a little, but it gets easier and more routine with time. Good luck!
posted by chrisamiller at 1:56 PM on March 19, 2017

Biologics can sting quite a bit right as fluid is entering the tissue. (I think it has something to do with the acidity of the medication being different from the natural pH of the body's tissues.) What I've found is that if I inject it very slowly, instead of all at once, I can reduce the stinging to almost nothing. Aim for an injection time of 2-3 minutes -- so, quite slow.

Of course, this depends on how your son feels about needles. He might prefer to get it over quick & have it sting a bit: I know people who do! Seconding the suggestion for ice.

With Humira, there's the possibility of injection site reactions. They present sort of like a huge mosquito bite/hive. Do know that these aren't dangerous and will eventually go away; for me it took 4-6 months.
posted by stellarc at 2:11 PM on March 19, 2017

Weekly autoinjector user here. Stomach is *way* better for me than thigh. That and letting it come to room temp and letting the alcohol evaporate after swabbing. I exhale completely first too-- I find that keeps my belly squishier than inhaling / clenching my muscles.

Regardless it still hurts about half the time. I always give myself a nice treat afterwards.
posted by travertina at 2:19 PM on March 19, 2017

A bag of peas works well for topical numbing if you don't want to do ice cubes. You can also do the gate control theory of pain: as you inject, provide an alternate stimulus somewhere else (e.g., inject in the abdomen below the belly button while pinching the skin, but repeatedly flick the other side of his abdomen somewhat firmly). I do this for some patients when I'm doing a cervical block and it seems to help.
posted by stillmoving at 2:34 PM on March 19, 2017

I'm not a fan of the pens -- highly prefer the syringes. I leave them out for 1-2 hours before injecting them, and then go as slowly as I need to.

See also: this question
posted by majikstreet at 3:37 PM on March 19, 2017

Syringes are so, so much better than auto-injectors.
posted by bile and syntax at 4:07 PM on March 19, 2017

One thing I found when I went hunting for tips was to TRY not to tense up, which can be really hard to do while pinching and trying to hold it level and watch the window and not screw up etc. Try to sit or lean on something so he's not tensing his abs/thigh, work in bright light, etc. It may help to find him a long quote or mantra to use - it'll also help him not to hold his breath, which doesn't help any.

But honestly, to some extent it's a matter of perspective. The first time is scary, and it's a big ol' piece of equipment that seems intimidating until you get used to it, but the pain should be no big deal once the first time is over. Your son's young enough that maybe the methotrexate didn't completely poleaxe him for a day and leave him at about 70% the rest of the week, but Humira has been such a relief for me and my (adult, but nervous) family member on it because he feels like a human being all the time now. A couple minutes of stinging and the entire ordeal is totally over. He gets himself a treat because it's a little stressful, but he looks forward to Injection Mondays on the whole.
posted by Lyn Never at 4:08 PM on March 19, 2017

One thing I have found in terms of the physical process of injecting (insulin, pen, never tried syringe) was to make sure the needle was at exactly 90 degrees to the skin. Otherwise it would sting quite a bit.
posted by Martha My Dear Prudence at 4:14 PM on March 19, 2017

One thing that helped me with Humira specifically was sitting quietly for ten minutes after I injected it (rather than getting up and walking the twelve steps from my chair to the bed.) It really made a difference in the burn.
posted by restless_nomad at 4:37 PM on March 19, 2017

Use the shortest needles. The Mini pen needles hurt much less than the regular or shorts and don't require as much pinching of the skin. A psychological trick is to inject through your pants into the abdomen. Not seeing skin makes it a little less squicky.
posted by a humble nudibranch at 5:56 PM on March 19, 2017

If he can stand it, I HIGHLY recommend the syringe. The pen involved getting a friend to administer, having a near panic attack before hand, tensing every muscle in my body, and letting out a string of curse words during the 10 second injection.
The first time with the syringe, I iced my thigh and literally DIDN'T FEEL IT. I dispense with the ice now, and it burns a tiny bit, but nothingnothingnothing like the pen.

I find the stomach painful - but I don't do the top of my thigh either. I find a chunk of flesh on the inside of my thigh pretty high up and that seems to be the best place.

I do let it warm up completely, like several hours. It can be unrefrigerated for up to 2 weeks so I don't worry about a few hours.
posted by raspberrE at 6:32 PM on March 19, 2017

I used Humira for a little over a year. Always with the syringes, except one time when the script got mixed up for the auto injector. I really didn't like the Humira Pen. IMO, it's a clumsy mechanism. And yes it wasn't pleasant even when taking all the precautions mentioned above. The syringe is so much better.

As a side note. I also self injected MTX for several years to minimise side effects before recently returning to the tablets. It's also supposedly more effective as the MTX avoids the digestive track as well.

Side, side note. I've also recently changed from Remicade to Cosentyx. The auto injector is the only option covered by the PBS (Australia). I was so not looking forward to using it. But, compared to the Humira pen, this is a thing of magic. Very easy to use. Absolutely no pain or surprise from the actual jab. The Abvie folks should get their act together and improve theirs.
posted by michswiss at 7:17 PM on March 19, 2017

There is a device called a Buzzy that supposedly makes shots less painful. My sister bought me one, but I live alone and don't have three hands, so I found it too hard to use. (They claim a single person giving an injection can use it though.) It's marketed for younger kids, so I'm not sure how a teenager will feel about it.

Here is a review of Buzzy and another device called a ShotBlocker.

I also read somewhere (maybe on the green) that listening to loud music can help, and I found that to be the case.
posted by FencingGal at 7:21 AM on March 20, 2017

Nthing using the syringe. The ability to control the rate of the injection reduces the pain so much, you can stop if it stings and start again, taking as long as you want. Doing it all at once is about the most painful way an injection like this can be done. Also Nthing injecting in stomach and letting the Humira warm up.
posted by k8oglyph at 12:37 PM on March 20, 2017

Just a quick note to offer that my experience of Humira injections has not been particularly painful or problematic. I use the pen-style auto injector every two weeks, never have had any site reactions or scarring. It feels like a brief pinch, to me. Certainly less painful than a stubbed toe or a tattoo or a kitchen burn. Not that this helps to alleviate if the experience is painful in another's case, but I did want to note that my experience with it has not been dreadful.
posted by mwhybark at 3:03 PM on March 21, 2017