A shot into the muscle hurts in two parts: the needle breaking the skin, and the medicine pushing into the muscle. Different tricks target different parts of that pain. Small, cheap steps such as pressing on the spot, using a little ice, or listening to music before the needle goes in can lower it, and none needs a prescription.1PubMed. An experimental study on the use of manual pressure to reduce pain in intramuscular injections2Clinical and Experimental Health Sciences. The Comparison of The Effectiveness of Local Ice and Manual Pressure Application in Decreasing Pain Related to Intramuscular Injection3International Journal of Caring Sciences. The Effect of Music and the Pressure Applied on Pain Induced by Intramuscular Injection Some of the biggest differences come from choices the nurse makes, such as where the needle goes and how fast the medicine goes in, and these are fair to ask about. Most steps trim the pain rather than erase it, so stacking two or three usually helps most.
Steps You Can Take Right Before the Needle
Pressing firmly on the injection spot for a few seconds just before the needle goes in lowers how much the shot hurts.4PubMed. An experimental study on the use of manual pressure to reduce pain in intramuscular injections Not every trial agrees, though. In one, pressure alone did no better than a normal injection.5International Journal of Caring Sciences. The Effect of Music and the Pressure Applied on Pain Induced by Intramuscular Injection In the clinic, you can ask the nurse if you may press the spot for about ten seconds, or ask them to do it.
Cold numbs the skin. Holding ice on the spot before the shot lowered injection pain about as well as manual pressure in one trial.6Clinical and Experimental Health Sciences. The Comparison of The Effectiveness of Local Ice and Manual Pressure Application in Decreasing Pain Related to Intramuscular Injection A typical approach is an ice pack moved in slow circles over the spot for at least 20 seconds, or until the skin feels numb.7Benha University Journal (or Faculty of Nursing, Benha University). Effectiveness of Cryotherapy on Pain Relief among Patients Receiving Intramuscular Injection Wrap the ice in a thin cloth or a plastic bag so it chills the skin without harming it, and don’t hold it on so long that the skin gets raw. You can bring a small cold pack in an insulated bag, or ask whether the clinic has one.
Distraction lowers the pain you notice. Listening to music during a shot lowered pain scores by about a third in one trial, from about 3 out of 10 to 2.8International Journal of Caring Sciences. The Effect of Music and the Pressure Applied on Pain Induced by Intramuscular Injection Watching a video through virtual reality glasses, or looking at optical illusion cards, lowered pain and left people more satisfied during painful penicillin shots.9PubMed. Virtual reality and distraction cards to reduce pain during intramuscular benzathine penicillin injection procedure in adults: A randomized controlled trial Pairing one physical trick, like pressure or ice, with one distraction may help more than either alone.
A tense muscle tends to make the shot feel worse. Many people tighten up in the seconds before the needle, and a clenched muscle aches more once the medicine is pushed in. While the nurse swabs your skin, drop your shoulder, let the arm hang loose (or lean on the opposite leg), and breathe out slowly. Not watching the needle helps many people stay loose.
If needles make you feel faint, eat and drink normally beforehand, since an empty stomach and low fluids make light-headedness more likely, and tell the nurse if you have fainted before so you can lie down.
Numbing Creams, Vibration Devices and Sound
Numbing cream works on muscle shots too. EMLA, a cream containing the numbing drugs lidocaine and prilocaine, lowered both the needle prick and the pain of the medicine going in during flu shots.10Canadian Journal of Hospital Pharmacy. Effect of Lidocaine-Prilocaine Cream (EMLA®) on Pain of Intramuscular Fluzone® Injection In children, the cream cut needle-prick pain by more than half and pain from fluid pushed into the muscle even more.11PubMed. Topical application of lidocaine-prilocaine (EMLA) cream reduces the pain of intramuscular infiltration of saline solution Part of the benefit is expectation, since a plain petroleum jelly cream also eased pain in one trial.12PubMed. Efficacy of the topical anesthetic cream, EMLA, in alleviating both needle insertion and injection pain
The cream needs planning. It takes time to soak in, and packets usually advise applying it about an hour beforehand, so putting it on in the waiting room is usually too late. Squeeze a thick layer onto the exact spot, not rubbed in, and cover it with a clear dressing so it stays put and doesn’t smear onto clothes. Tell the nurse where you put it, so the needle goes into the numbed patch and they can wipe the cream off before cleaning the skin. It’s sold over the counter in many countries, and a pharmacist can advise.
Buzzy is a small device that pairs vibration with an ice pack and is pressed near the spot before and during a shot.13PubMed. Effectiveness of Buzzy® for pain relief in children during intramuscular injections: Systematic review and meta-analysis It may lower injection pain in adults who are fearful of shots.14PubMed. Effect of the Buzzy Application on Pain and Injection Satisfaction in Adult Patients Receiving Intramuscular Injections Vibration and virtual reality both lowered muscle-shot pain in one emergency department trial.15PubMed. Effect of Distracting Methods on Procedure-Related Fear, Anxiety, and Pain During Intramuscular Injection: A Randomized Controlled Trial In toddlers, placing it 15 or 30 seconds before the shot gave similar relief, suggesting exact timing may matter little.16Cogitare Enfermagem. The effectiveness of Buzzy® in reducing pain associated with intramuscular injection in children: randomized clinical trial
Sound may help as well. Low hum sound frequencies of 150 to 200 Hz played during a shot lowered pain and eased the rise in heart rate in one trial.17PubMed Central. Effects of Sound Frequencies on Pain and Comfort During Intramuscular Injection: A Randomized Controlled Study This was a single study, so treat it as promising rather than proven.
Which Injection Site Hurts Least
The ventrogluteal site sits on the side of the hip, just below the bony ridge of the pelvis, rather than on the back of the buttock. It has no large blood vessels or nerves nearby and lies well away from bone, so it is widely regarded as the safest and least painful site for muscle injections.18International Journal of Caring Sciences. Using Ventrogluteal Site in Intramuscular Injections is a Priority or an Alternative? Pooled trials found somewhat less pain there than in the back of the buttock, but more studies are needed.19PubMed Central. The effect of intramuscular injection technique on injection associated pain; a systematic review and meta-analysis The nurse finds the side-of-hip site by placing the palm on the hip bone and spreading two fingers into a V, then injecting in the middle of that V.
Needle length matters for the site too. A standard 25 mm needle may be too short for larger people or too long for very slim people.20ScholarWorks. Intramuscular Injection Guideline Revisions are Needed Based on Body Mass Index, Needle Length, Sex, and Skin to Muscle Depth In larger people, especially women, buttock shots often need longer needles to reach the muscle.21ScholarWorks. Intramuscular Injection Guideline Revisions are Needed Based on Body Mass Index, Needle Length, Sex, and Skin to Muscle Depth A shoulder shot placed too high can land in the joint’s cushioning sac instead of muscle, causing pain and stiff movement that can last.22ScholarWorks. Intramuscular Injection Guideline Revisions are Needed Based on Body Mass Index, Needle Length, Sex, and Skin to Muscle Depth
You can ask whether the shot can go into the side of the hip, arm or thigh instead, as the choice is often flexible. Some medicines or larger volumes need a particular muscle, so a nurse may decline for a good reason, and it helps to ask why. If you had a sore shoulder or stiff movement after a past shot, mention it so the nurse takes extra care with placement.
For injections at home, rotate sites so the same muscle isn’t hit every time, and learn the landmarks from your nurse before doing it yourself. Your pharmacist can tell you whether your needle length fits your build.
Technique Changes the Nurse Can Make
In the Z-track technique the nurse pulls the skin to one side, injects, then lets go so the needle path closes off like a zigzag. This keeps medicine from leaking back out toward the skin.23PubMed. The Effect of the Z-Track Technique on Pain and Drug Leakage in Intramuscular Injections In trials it lowered pain compared with a standard shot.24PubMed. The effect on pain of three different methods of intramuscular injection: A randomized controlled trial25RESEARCH REVIEW International Journal of Multidisciplinary. Effectiveness of Z Track Technique Versus Standard Technique on Pain Perception During Intramuscular Injection among Patients Underwent Orthopaedic Surgery In another trial it reduced leakage without clearly reducing pain.26PubMed. The Effect of the Z-Track Technique on Pain and Drug Leakage in Intramuscular Injections It is often used for medicines that can irritate tissue or stain skin. If past shots hurt a lot or leaked, you can ask whether the Z-track method suits you.
For buttock shots, lying face down with the toes turned inward relaxed the muscle and lowered pain in one trial.27PubMed. The effect on pain of three different methods of intramuscular injection: A randomized controlled trial If you are lying down for a shot, it is reasonable to ask whether you can turn your toes inward.
Speed and needle size also play a part. Pushing a steroid shot over 30 seconds instead of 10 led to less pain, and the pain wore off sooner.28PubMed. Effect of methylprednisolone injection speed on the perception of intramuscular injection pain For penicillin shots, slowing the push did not change how much it hurt.29PubMed. Effect on pain intensity of injection sites and speed of injection associated with intramuscular penicillin So slowing down helps some medicines more than others. Asking “could you push it slowly?” is a reasonable request, especially for steroids, though a nurse may weigh the drug and volume. Thinner needles make pain during insertion less likely, mainly shown with very fine needles under the skin.30Australian Journal of Advanced Nursing. Choosing wisely: needle length and gauge considerations for intramuscular and subcutaneous injections Telling the nurse you’re nervous, or that past shots hurt a lot, lets them adjust pace and position.
Helping Children and People Who Fear Needles
Words shape the pain. People told to expect a “bee sting” felt more pain from the same dental injection than those told it would be comfortable.31PubMed Central. Determinants of Pain Perception and Patient Satisfaction in Dental Local Anesthesia: A Comprehensive Meta-Analysis of Verbal Cues, Mechanical Interventions, and the Expectancy Disconfirmation Model Calm, neutral words like “pressure” or “a quick pinch” help more than dramatic warnings.
A single cough as the needle goes in eased pain for some children having vaccines, though not for all groups studied.32PubMed. The “cough trick:” a brief strategy to manage pediatric pain from immunization injections It’s harmless to try but shouldn’t be counted on.
To prepare a child, tell them honestly but briefly and close to the time, since long warnings give them time to worry. Hold them in a hug-like position on your lap rather than pinning them down, which feels safer and keeps the limb still. Give them something to look at or do, such as a video, bubbles or a favourite toy. For planned shots, numbing cream an hour before can take the edge off the needle prick.
Adults with strong needle fear can tell the nurse so they can lie down, which lowers the chance of fainting. Ask ahead for numbing cream or a vibration device so they are ready, and bring someone along or wear headphones to give your attention somewhere else. If fear makes you avoid care, talking therapy can treat needle fear, so it is worth raising with a doctor.
Easing Soreness After the Shot
A sore, tender muscle for one to two days after a shot is common and comes from the medicine and the small injury to the muscle. A normal ache is dull, tender when pressed or moved, and improves within a day or two. A small bruise or slightly raised spot at the site can also be normal. Cold needles did not reduce pain but did reduce bruising in one trial.33PubMed. Needle temperature effect on pain ratings after injection
Gentle movement, such as using the arm or walking, helps keep the muscle from stiffening. A cool pack held on for 10 to 15 minutes can ease swelling and tenderness, with cloth between it and the skin. Over-the-counter pain relievers can help if your doctor or pharmacist agrees they suit you. After a Z-track shot, avoid hard massage of the spot unless told otherwise, since it may push medicine back along the track.
Some symptoms need checking. Pain that gets worse after two days, or spreading redness and warmth, may mean infection. Shoulder pain and stiff movement that last weeks may mean the shot landed in the joint area. Numbness or shooting pain down the leg after a buttock shot should be reported. Fever, rash or swelling of the face points to a reaction and needs urgent care.