Injection from new doc was agony - what happened???

Hi, I got my second loading injection today and the damn thing was agony - just like the intramuscular injections I remember so well from a stay in hospital - but what happened? My first one was from my regular doctor and it was pain-free. Just a small sting as the needle went in and then blissful nothing. He said that B12 wasn't a toxin and it wouldn't hurt as much as the ones I got in hospital, which they give everyone, supposedly to ward off DVT. Damnable things - shoved in your thigh every night, and they burnt and cramped like hell.

The new doc I had tonight is a genuine newbie, as in she's just qualified and looks about fourteen. She didn't tourniquet my arm. At first there was just a sting and I thought, 'Cool, these are going to be no problem', but then as, I assume, she put the B12 in, it started to hurt like merry hell, with, yes, the full stinging, cramping, burning pain. Then pain as the damn thing came out, and aching for half an hour afterwards. To make it all just perfect she didn't even offer me tape afterwards, to hold the cotton in place - I had to ask for it.

She wasn't brusque or unpleasant, but she did seem tense and uncertain, complaining about the glass vials and seeming a bit flustered. Was she just new and anxious or has she got something wrong? Or is it the other way round - did my own doc not get it into the muscle correctly and pain is the normal response? Should 'new doc' have put a tourniquet on, as my own doc did? Does that help the pain?

Any old hands, who've had lots of injections, got advice for the perfect injection here? I'm seeing her for another one on Friday, worst luck, and if I can ask her to do something - such as tourniquet the damn arm - then I'd love to know what!

Any tips to get through this pain-free, or as near as damn it, most gratefully accepted.

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  • Hi Chancery,

    B12 IM injection can hurt/ sting a lot if its injected to quickly and the liquid is very cold. Its thick stuff and should ideally be injected at body temp and very slowly into the muscle. The new GP may have injected to quickly and or hit a vein, do you have a bruise now?

    Perhaps have a read of this:

    pernicious-anaemia-society....

    Tips for more comfortable B12 injections:

    I have never some across a tourniquet being used for B12 injections, but perhaps it helped , I do not know,

    The glass ampoules can be difficult to open, she may have had a difficult one where to the top just shatters, instead of just breaking off.

    I hope the next one will be better, just ask for the ampoule to be warmed up (rub in between hands until warm) and for it to be injected real slow,

    Kind regards,

    Marre.

  • Hi Marre, thanks for the link - very informative. It was a cold day, and it was stuck in my bag with no chance to warm up, and I think she did it too quickly, now I look back at it; it was done in seconds. Tomorrow I'll warm it in the waiting room and ask her to inject it as slowly as possible. Hopefully that will dull it down. Maybe she'll learn by example!

  • If you completely relax your arm - or where ever - it does help a lot, mine use to hurt a lot more when I first started having them because I was tense. I also - wimp that I am - take a pain killer beforehand which helps though whether that is all in my mind or not I don't know.

  • Thanks, Jo, more tips - they're all handy. I probably was tense. I was watching her like a hawk because she was new to me and I'm not good with new when it comes to doctors! I shall be all Zen and hopefully that will at least make me not care even if it does hurt! Failing that - painkillers WILL be the order of the day...

  • I'd be inclined to think it was mainly nerves - doctors are frequently quite bad at giving injections or doing any blood work and cause more pain as a result than nurses who are doing it more frequently.

    As Marre says if the fluid was cold then it would sting a lot as well - they tend to store ampoules in the fridge so they are way off body temperature unless they are warmed in the hands first.

    Like Marre - not come across use of a tourniquet for B12 shot.

    Are you noticing any benefit yet - know that sometimes it can take a while.

  • Hi Gambit, yeah, I think the tourniquet was either my own doc's personal quirk or just plain dizziness. He can be a bit ditzy! At first I was annoyed cause I thought she did it really badly, then the more I thought about it the more I thought, 'Well, why would you tourniquet an arm if you are not taking blood out?' Chances are he got it wrong, or, as I say, it's just his personal quirk for beating pain. He'll be doing it again on Monday. If he tourniquet's my arm again I'll ask him. You never know, this might be a little known method for pain control!

  • I've never had a tourniquet used on me for any sort of injection. I thought they were only used to raise a vein for intravenous injection or drawing blood.

    I've had a number of painful B12 injections from nurses in the past and, as has already been said, it's usually due to the B12 being cold and injected too quickly. DIY is much less painful.

  • Hi, being a nurse myself and a patient recieving my B12 injections, I agree with previous posts. Injecting it slowly and warming the vial up, decreases the pain. Am the worlds worse patient ha ha, and I get very frustrated when my g.p practice nurse injects me in two seconds flat and leaves me in pain each time and quiet often am left with a bruise. I always inject slowly for my patients , also once its drawn up ensure the needle has been changed before administering it. Dont be shy to question your nurses practice, after all its your body.Am more than happy to hear my patients experience s. Touch wood I've had no complaints, maybe I should inject myself.

    Good luck

  • Hi Fluffpuff, nice to hear it from a nurse! My practice nurse is apparently on holiday; that's why I'm being shuttled round all the docs, here and there, getting injections where they can squeeze me in. I'm hoping she'll be back next week and I can get appointments at a more convenient time, and hopefully given more consistently - as long as they are not consistently sore!

    Seriously, I'll be asking both hers for it REAL slow, every time (sorry, that managed to sound rather smutty!). I shall risk the displeasure of them all - anything to avoid pain. But what do you mean by "once its drawn up ensure the needle has been changed before administering it"? They always make the needle up across the room so I can't really see what they are doing. What is it I need to watch out for, and why?

  • When doing an intramuscular injection they will use one needle to draw the fluid up into the syringe and then change that and use a second to actually inject using a clean needle.

  • Ah, so does this make a difference to the pain somehow? I must admit I'd feel very reticent to challenge a medical professional with 'Have you changed that needle?' Is it dangerous or something? And how would I know they'd changed it, if I couldn't see what they were doing, for example? What SHOULD it look like?

    God, you can tell I'm new at this. I feel like I'm four; it's all why, why, why?

  • Had sort of assumed it was to do with risks of cross contamination but thinking about how others have described the process of doing an intra-muscular injection I think different sized needs are used to draw the fluid in to the syringe - probably a wider one - and then a finer one to inject.

    It isn't something that is possible when I do subcutaneous as insulin syringe and needle are integrated ... mind you I suspect I'm a bit of a hygiene nightmare - one reason I don't use contact lenses :)

    At the very least you could probably hear the discarded needle being dropped into the sharps bin even if you can't actually see what they are doing. If they have stuff out on a tray at the start then you would see two packs for needles.

  • Yeah, Gambit, I saw on a leaflet that Engels gave me (I think it was!) that you are supposed to change to a finer needle for the injection. I don't know why I didn't connect the two things - informational overload, I think! But judging by the various responses on here, it doesn't seem to matter unduly, other than for pain of the needle actually going in. That's a flea bite compared to the cramping and burning when they put the B12 in, so I'm not going to worry about it. One less thing to obsess over!

  • A blunt needle will hurt as the needle is being inserted. It will make no difference whatsoever to the pain of the hydroxo being injected when the plunger is pressed.

    I never bother changing the needle. I'm always careful not to blunt it on the bottom or side of the ampoule when drawing up and then just jab. It's not caused me any problem in 100+ IM injections.

  • I've had blunt needle, whole top of needle missing, nothing happens then, just denting the skin. I do now always change needle, but also to a finer needle, for comfort and looks (no punch mark).

  • Why don't you just use the finer needle to load the syringe? I just use a single 23g for each injection.

  • As my B12 comes in 2 ml ampoules and I have just used the 23G needle to find that difficult to empty the ampoule and have had the top of the needle missing, blunted etc. So easier to use 21G (its longer) for sucking up, then changing to 23G for injecting.

    I find it easier using 2 needles, and quicker.

  • Each to his/her own I suppose. I also use mainly 2ml ampoules and don't find any problem with a 1.25 inch 23g needle for both loading the syringe and injecting.

  • You only use a tourniquet for an intravenous injection.

  • Ha! Poppet, tell that to my doctor. He obviously didn't get the memo.

  • Hiya,

    Mine are always painful when I have them, but I think that's because the nurse gets it out the fridge while I'm sat there! The needle going in is okay, it's just when the syrup type stuff goes in, feels like someone has given you a dead arm with pain!

  • Yeah, Fidgetter, dead arm describes it exactly, except there's some extra burning and stinging thrown in for good measure.

  • They don't keep b12 in the fridge at my surgery (I keep mine in a drawer at home too) they don't change needle and I don't when I SI either - never been a problem with blunting or anything x

  • No, Kip, I was sent home with mine too - doc said, and I quote, "I'd rather you kept them. Just bring them in with you." I always fret I'll trot all the way down to the surgery only to discover I've left them at home! But at least this way I can now, armed with my new knowledge, sit and warm one up in the waiting room beforehand. Going for another one today so we'll see if it works!

  • Hope its a better experience for you today!

  • Thanks, Marre, it was much better. Not pain-free, but better. I didn't have a chance to warm it up because the doc was early (I know, imagine!) but I asked her to inject it really slowly and she was more than happy to do it. So a far less painful experience. Still got the dead arm and a fair bit of stinging but not the burning pain - so a good result.

  • I did warn you. Hydroxocobalamin stings, it just does. You just get used to it.

    Hope the injections will help you a lot, then you will know its all worth the sting.

  • I hope so too, Marre, otherwise I will doubtless fall into an even deeper slough of depression!

  • Right, think positive, they will work!!

    It will be worth the sting!

  • My experience is that 2ml hydroxo solutions sting far less than the 1ml solutions used by the NHS.

  • That's a weird one, Engels. You'd imagine it would be the same solution, wouldn't you? But I suppose if the 2ml is coming from a different manufacturer from the 1ml it could have different additives.

  • The only "additives" are a small amount of salt and vinegar. That the 2ml solutions sting less is obvious if you think about it. Both 1ml and 2ml contain the same amount of hydroxo but the 2ml is diluted with more water so is bound to sting less. It's like adding lemonade to beer or water to whisky.

  • Once again, I show my ignorance - I didn't even know there was ANY water! It's a live and learn process alright...

  • Was the second injection site any where near the first site? I've found with weekly injections (which is similar to your sequence of loading doses) that after the new injection, the pain is at the previous injection site. It's like a sympathetic reaction, but I think it is actually chemically reacting at the old site.

  • That's weird you should say that, Pvanderaa, I get something like that, AFTER injections. I nearly always get pain/itching at old injection sites. I found that I kept rubbing the crook of my arm this time, where I had previously given blood, and then I realised that wasn't where I got the B12 injection that day! And it's not the first time it's happened either. Baffling - and I thought it was just me!

  • I also get pain at the old site when I do physical work or exercise. I presume the exercise releases B12 from the muscles and the old injection sites react to the increased level in the blood stream. I take this pain to be a good sign that I've got a good level of B12 in my blood stream and nothing to worry about.

  • No, I just get random itching and stinging at old injection sites on the same arm for about two days afterwards. There is nothing as strange as the human body....

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