Impact of injection speed and volume on perceived pain during subcutaneous injections into the abdomen and thigh: a single-centre, randomized controlled trial

• Published in: Diabetes, obesity & metabolism Vol. 16; no. 10; pp. 971 - 976
• Main Authors: Heise, T., Nosek, L., Dellweg, S., Zijlstra, E., Præstmark, K. A., Kildegaard, J., Nielsen, G., Sparre, T.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2014; Wiley Subscription Services, Inc
• Subjects: Abdomen; Adult; Aged; Clinical trials; Diabetes; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 2 - drug therapy; Double-Blind Method; Female; Glucagon; Humans; Hypoglycemic Agents - administration & dosage; Injection; injection speed; injection volume; Injections, Subcutaneous - adverse effects; Injections, Subcutaneous - methods; Insulin - administration & dosage; Male; Middle Aged; Pain; Pain - prevention & control; Pain - psychology; Pain Measurement; Pain Perception; Patient Acceptance of Health Care; Reproducibility of Results; subcutaneous injections; Thigh; Treatment Outcome; diabetes; injection volume; injection speed; subcutaneous injections
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.12304

Aim The aim of this study was to assess pain associated with subcutaneous injection into the abdomen and thigh of different combinations of injection speeds and volumes. Methods The study was a single‐centre, one‐visit, double‐blinded, randomized controlled trial in 82 adults with type 1 or type 2 diabetes receiving daily injections of insulin or glucagon‐like peptide‐1 (GLP‐1) agonists. Participants received 17 subcutaneous injections (12 in abdomen, 5 in thigh) of saline at different injection speeds (150, 300 and 450 µl/s), with different volumes (400, 800, 1200 and 1600 µl), and two needle insertions without any injection. Pain was evaluated on a 100‐mm visual analogue scale (VAS) (0 mm no pain, 100 mm worst pain) and on a yes/no scale for pain acceptability. Results Injection speed had no impact on injection pain (p = 0.833). Injection of larger volumes caused significantly more pain [VAS least square mean differences 1600 vs. 400 µl, 7·2 mm (95% confidence interval – CI; 4.6–9.7; p < 0.0001); 1600 vs. 800 µl, 7.2 mm (4.4–10.0; p < 0.0001); 1200 vs. 400 µl, 3.5 mm (0.4–6.6; p = 0.025) and 1200 vs. 800 µl, 3.6 mm (0.4–6.7; p = 0.027)]. Significantly more pain occurred in the thigh versus the abdomen [9.0 mm (6.7–11.3; p < 0.0001)]. Conclusions Injection speed had no effect on injection pain, whereas higher injection volumes caused more pain. The results of this study may be of value for guiding patients to use the appropriate injection site and technique to reduce their injection pain. Furthermore, these findings may have important implications for the development of new injection devices and drug formulations for clinical practice.