Injection sites with Enbrel

Help! I have been on Enbrel for 3 years now and am getting really sore at all my injection places. I inject into the fat in both thighs, both hips and stomach. Is there any place else we can try to give the other sites a rest? I no longer have a red swollen site at the injection but my thighs are killing me and really sore from all the injections.

I'm sorry you're having trouble! [[hug]]

I think you can also inject on the back of your upper arm. It's a bit awkward but my dad does it for his insulin and he's gotten the hang of it.

Carolan is correct you can in the back of your upper arm. You should be able to inject anywhere there is enough fatty tissue between your skin and the muscle (though I would double check with your rheumy). 

My temporary Male Nurse ( a friend of my son's) injected mine in the back of my arms when he was home from Iraq and Japan.

Per the instructions in the package it does state the upper arm. I just doubled checked with the package I have in the fridge.

Tess

Previously TessaD wrote:

Carolan is correct you can in the back of your upper arm. You should be able to inject anywhere there is enough fatty tissue between your skin and the muscle (though I would double check with your rheumy). 

My temporary Male Nurse ( a friend of my son's) injected mine in the back of my arms when he was home from Iraq and Japan.

Per the instructions in the package it does state the upper arm. I just doubled checked with the package I have in the fridge.

Tess

Thank you I will give it a change. pinklady

Yes, thighs can get sore...I just stick to my stomach and inject away.  I rotate around my stomach as much as I can, and my stomach looks pretty much like a pin cushion..but it never bothers me or hurts.

Good luck

Hi,

After everyone's complaints about the discomfort of injecting Enbrel I always felt quite fortunate that it never bothered me.   However, that all stopped a few weeks ago when it started to really sting, even when injecting incredibly slowly (my tip).   I certainly agree though that the stomach is the least painful providing that you don't inject too high as I once did.

Hope things improve.

Dozey.

Don't forget to make sure you are two finger lengths away from the belly button at the minimum. (per the instructions I received when I had to inject my dad all the time, by the nurses.) 

June, try the hard candy bit with the for the stinging. It does work. 

Tess

whats the reason for being away from the belly button? (I'm just learning to inject myself in the belly so don't know much about it)

Kate, To be honest I do not know the "reason" it was something that stuck in my mind when they were instructing me to give my father his injections by several nurses and the home hospic nurse that stated all injections should be at least two finger lengths away from the belly button.  

I have an appt on Thursday with my Primary I can ask if you want me too.  Or call ask my male nurse friend on his facebook but he is in Japan and might take a few days to find out anyway. 

Thanks Tess! I believe you, I was just curious! do you mean two lengths of a finger like almost 6-8 inches away?

hmm. I wonder if somehow its in case you poke something important in there? (although *ahem* I am fairly sure that I have enough padding that the needle is not exactly on the verge of puncturing any internal organs .

No it should equal about 2 inches away so it is really the WIDTH of two fingers not the length of them.  Sorry If i stated length. My bad.

I have problems with vertical and horizontal also..maybe because I am vertically challenged!!!

Hi, I'm a newbie to Creaky Joints and relatively newly diagnosed with RA (just last winter.) I've been on Enbrel since September and I still can't muster up the courage to inject myself. My super-supportive stud of a boyfriend gives me my injections into the jiggly bits of my arms.

I couldn't help but notice your comments about the stomach being the LEAST painful injection site??? I'm amazed! The injections in my arms hurt so stinkin' badly (or maybe I'm just a big wuss). I don't want to imagine what it would feel like in my stomach. I already tried the hard candy thing, after reading previous posts, which does absolutely nothing for me. Honestly, I think that the majority of it is all in my head. I'm psyching myself out too much. 

So, I'm here looking for a little encouragement. How did you find the strength and wherewithal to poke yourselves for the first time? Frankly, I'm really embarrassed that I can't manage to do it. I work in the veterinary field and have poked animals a million times with needles, but my own leg or stomach is an entirely different story. I even chicken out when my boyfriend's holding the needle. 

Nervous in Eugene, Oregon:

Claire

Hi Claire, welcome to the Creaky boards!

It's true, the belly area has relatively few nerve endings compared to other areas of the body, like hands and feet. I was already injecting methotrexate, which is nearly painless for me. Enbrel is a different story - it definitely stings!  It's easy to tense up in anticipation of the stick. 

No. 1, don't wipe the area with alcohol. Just out of the shower is clean enough. My routine is to get the syringe out of the fridge and lay it out with my piece of candy on the bathroom sink. When I'm done with my shower, moving quickly, I get out, walked over to the sink, pop the candy in my mouth, and inject without stopping to think about it first. I still have to inject slowly but it goes faster now. If I pause to "prepare" myself, it hurts worse. You can definitely psych yourself into being tense.

Mtx is painless in my belly area but stings like the dickens anywhere else like my arm or thigh.

Ask your doctor for an injection site "map", but in general you can inject anywhere between your hip bones on the sides, and the hairline and a couple inches above the navel "north and south".   It's recommended you don't inject within an inch or two of the navel. If you're like me and have a little "belly roll", that's a good target. LOL

I always inject in the belly area, making sure I alternate sides from week to week. It also helps not to pinch the area (unless you're using an auto-injector, in which case you'll have to pinch up an inch)

My doctor's assistant guided me through my first injection, and after that I got used to it pretty quick. The PA's are trained to help you - trust them!

Hang in there! You can do this! (On the other hand, if your hunky boyfriend doesn't mind, why mess with success? [grin])

Ok- its ok. Injecting yourself for the very first time is REALLY REALLY hard. But, it is not impossible. I had to do that for the first time when I initially went on enbrel, and I had never injected anything at all. I think I sat there for 10 minutes starting at my bare leg, blaring music to pump myself up ( ) before I got up the guts to do it. I read somewhere that there is a very strong, very basic instinct to maintain the integrity of your own skin (which is why seeing your own blood or a cut on your skin can be upsetting) and that this instinct is part of why injecting yourself is so hard. But, all you really have to do is do it once and you get over it- the first one is the worst! After that, you know that you've done it and survived, and it ends up being less scary.

I know that stomachs are supposed to be better, but I almost always do my humira in my legs because I'm a big chicken. I can finally do methotrexate in my stomach though, because that shot doesn't feel like anything at all. 

You'll be ok!!

Claire,

First WELCOME to Creaky. You are in the right place for a community of support! The ladies and gents on this board have been fabulous.  I joined in July and have made this a daily stop during the day.  I really feel that the folks here are true friends that also suffer from the same disease and they give guidance, advice and support when needed, ask for and even when not. 

Below is the link the the medication instruction guide for Enbrel.  It will take you to a PDF File Page 1 is for Auto Injection, Page 2 is for prefilled syringes (most common), Page 3 is for prefilled Vials. 

http://www.enbrel.com/pdf/enbrel_piu.pdf

I also had a hard time the first time I had to inject myself even after spending many years injecting other humans with insulin, blood thinners etc (no i am not a medical professional, this was all for family members. Yea I know sucker is written on my forehead).

I of course started in my thighs hurt like heck!  I do the same ritual as Carolan described. It is quick and faster now once you get accustom to it. You just need to take the plunge and try it.  One thing I do, do is imagine that the injection site is the person I might be upset with at the time. (usually a character from a book not real people). 

Just make sure you are injecting at an angle per the instructions 45 degree, and that the angle of the needle is facing upwards.

Best of Luck to you on your first try solo!!!

Tess (Carolan's newiest book fan!!)

PS: When is the sequel to Beaudry's Ghost coming out???  (HA HA HA).

Thanks so much, ladies! Tomorrow's "Injection Day" and I'll try your suggestions. I'll let you know how it goes.

Hi,

Sorry I haven't written sooner but as today's the day I thought I'd check in and see how you got on.

It's not the needle that stings but the drug.   SLOW is the trick and that is still too fast, plunge the drug as slow as you can possibly do it and you may be surprised at how painless it is.   Depending on how I plunge dictates how painful it's going to be, anything from stinging to painless.   Yes it's true I once injected it and didn't feel it at all - SLOWLY, SLOWLY.

Good luck.

Dozey.

Tessa, I wasn't aware of the inject-upward-at-45-degrees thing. I did that today and was surprised at how much less it hurt! I don't know if the angle had anything to do with it or not - I'll have to keep track of it over the next few sticks. SMOOCH

Hi Tess,

I didn't know Enbrel had to be injected upwards - isn't that awkward?

I have been injecting it all ways, usually downwards, sideways or forward into a pinch of tummy but I shall try upwards next time.

Missed our chat these last few days.

Dozey.

Dozey,  When it states upward it is the slant of the needle should be facing upward not necessarily the syringe itself. 

Carolan, Smooch back at ya. 

Btw ladies the suggestions I have made here are directly from the instructions with in the package that comes with the Enbrel and/or from the website above.

I learned about the angle of the needle (point) years ago with insulin shots and have confirmed this for every type of injection from my GP.  Including Lovenox (a blood thinner) and Enbrel.  I will ask doc next time I chat with them on why...  They had given me the reason when I was injecting my father with the Lovenox and Insulin but for the life of me I blocked all that out of my mind for good reasons. 

June, I have missed our chats too my schedule has been crazy the last few days thanks to my daughter and grandkids. 

Here's hoping everyone is having a good day!!

Hi again Tess,

Sorry I always have to ask a question twice as it never sinks in the first time, I must be a bit daft.

I don't understand the needle facing upwards when you then go on to say that doesn't necessarily mean the syringe, surely the angle of one dictates the other.

I won't be on-line tonight for a chat as I've had the most horrendous day out - I no longer like shopping.   I never go into town these days, now I remember why.   I was so happy to get back to my little village where everything is much calmer and there are so many familiar faces.   Although I've only lived here for 5 years there are quite a few people here that are third generation which is lovely.   In the city it's just all strangers pushing and shoving each other to get what they want.

Anyway less of my moaning, I'm beginning to relax now.

Hope that you're well.

Hugs,

June.

X

June,

I understand about the shopping which is why i hate to go.  I try to stick to little local shopping centers here versus the larger malls and such.

As for the needle versus the syringe.  If you look closely at the tip of the metal porition there is a slant that is what should face upward (towards the chest area) not the entire (needle + syringe) facing up where you would be injecting at an awkward angle.

It would be easier if i could show you a picture, though i do not have any software to make my pictures small enough in size to post on Creaky.  Maybe I can create something in a graphic program and put out here in PDF or on Facebook.  I will look into it after my nap.

Today's PT session was pretty tiresome on me with the new stuff they are doing on my Neck and shoulders...Gave me one heck of a headache. 

My concern is the doctor is considering a dose of Steroids and I am not too sure I want to go that route.  The injections are great for temporary releif so I have to really ponder if I want the Steroid Pack to help kickstart the reduction of some of the pain and swelling I have been going through.  Oh well...off to napping...

so i have def learnt s/th new!!! i didnt even know that the hole was slanted, i just assumed that the needle was like a teet of a baby bottle - a hole at the top!!! i cant wait (!!!!!!) for Monday so that i can have a look at my Enbrel injection!!! wow, that's something amazingly exciting to look forward to!

hmmm, that sarcasm is making me sound really mean i will have a look def.....

xx

Rachel,

was that sarcasm? I thought you were just excited. We all share this disease and show our excitement in the little things we learn about it and only those who know can appreciated it...

Unfort over the years of taking care of others in my family and myself I have learned some things that i never knew would apply to us. as i remember them i will make sure i share.

Good luck on monday!!!

As I promised to post some type of picture of the injection:

Definition Subcutaneous

The term "cutaneous" refers to the skin. Subcutaneous means beneath or under the skin.

I will see if I can find anything else that is more helpful.

Here is a larger picture.

Hi Tess,

That looks like a picture of Sponge Bob Square Pants tummy, mine is definitely more rounded - ha ha ha!

Boy oh boy, the needle looks gruesome when you see a diagram like that, it makes me feel like a wild animal being handled by a veterinary surgeon using a gun dart.

Dozey.

Yeah, Dozey, the tummy in that picture is MUCH flatter than mine! [grin] 

And thank you for the visual of being hunted by a dartgun/blowdart. That was my first coffee spew of the day...

Hey Tess,

Injected my Enbrel around an hour ago via your instruction and...success!!!

It took a few squints and really a guess as to whether the needle was slanting in the desired direction as it's so fine and therefore difficult to see.   Whichever way it went in I didn't feel a thing from the needle, not in the slightest.   Of course the drug always causes a sting but that can be controlled, I now think of it as something nipping me which is bearable.   I think it's when we think of needles and stabbing that we really feel quite tense but, accept it simply as fluid and then think of the sensation as a nip and not a stab and it works for me.

Dozey.

Thanks for the info on the needle angle.  I was glad someone asked to clarify as I was also thinking of the awkward angle. 

Tomorrow is my turn to try the needle angle and hard candy tip.  It was comical the first time with Humira.  I have 2 friends who live around the corner and down the street who have been on Humira and Embrel.  One of my friends came over to help me and we were laughing so hard I didn't even really feel it.  When it was my turn the 2nd time, I had to tell my self over and over that I could do it by myself.    I really couldn't ask my husband to help because he would have fainted as he breaks out in a sweat anf fidgets whenever he looks at the small needle.  I just sucked it up and went for the plunge.  It stung so bad.

I will let you know how it goes.

Thank you all for your insights.  It truly helps.