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Overcoming the Fear of Self-Injection With Spondylitis Treatment

Updated on December 29, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Joan Grossman

  • Biologics are a class of medications, proven effective in treating spondylitis, that must be injected to work.
  • Fears around self-injection are common, but there are ways to overcome these fears and gain comfort and confidence with the process.
  • A health care provider will train you on self-injecting to ensure you use the correct techniques.

Many biologic drugs used to treat spondylitis (also known as ankylosing spondylitis) can be conveniently self-injected at home. It is common to feel wary of self-injection initially, but many people with spondylitis find that self-injection, when appropriate, has advantages over injections in a clinical setting.

Self-injection is frequently a topic of discussion on MySpondylitisTeam, where members share their tips on self-injected biologics. One member described their experience in overcoming their fears of self-injection. “I never thought I could do an injection on my own,” they wrote. The member described how the staff at their doctor’s office helped ease the process. “You will have [a registered nurse] assigned to you, who will be there for you as you learn how to do the injections.”

People with spondylitis often attribute their nervousness about self-injection to a fear of needles. “I hate needles so badly,” a member wrote. Another member said, “I’m afraid of needles, but have read really good things about biologics.”

More Independence With Treatment

Not every biologic can be self-injected, but when suitable, self-injection is a popular alternative to receiving injections in a clinical setting. Self-injections can help reduce visits to the doctor’s office and provide more self-reliance with managing treatment. Many people with spondylitis appreciate the flexibility and comfort of self-injection at home.

Learning how self-injection works may help you determine if this mode of treatment is right for you.

Why Must You Inject Biologics?

Biologic drugs consist of large molecules that cannot be properly absorbed in the digestive tract if taken orally. For proper absorption, biologics currently available for treating spondylitis must be taken by injection under the skin (also called subcutaneous injection) or by IV infusion directly into the bloodstream.

In recent decades, biologics have enhanced the treatment of autoimmune and chronic inflammatory conditions including spondylitis, rheumatoid arthritis, and psoriatic arthritis. They can significantly reduce symptoms, slow the progress of the disease, and improve quality of life for some people. This class of drugs targets proteins in the immune system that can be overactive in people with spondylitis.

Dysfunction in the immune system in spondylitis causes inflammation and a range of signs and symptoms, such as back pain, joint pain, stiffness, appetite loss, fatigue, and others that can affect organs and the gastrointestinal system. When the condition affects a person’s ribs, they may find it difficult to take a deep breath.

Biologic drugs that are currently approved by the U.S. Food and Drug Administration (FDA) for the treatment of spondylitis can be self-injected, and they include anti-tumor necrosis factor (or TNF) drugs and IL-17 inhibitors:

Different Types of Self-Injection

Three main types of self-injection are used for administering biologic drugs at home: prefilled syringes, self-injection pens, and e-devices, all of which come with the proper dosing. Talk to your doctor about the mechanisms of each self-injection method to find a treatment option that might work best for you. Depending on your particular condition and preferences, one method may have advantages over others.

Prefilled Syringes

A prefilled syringe consists of a syringe and needle and includes the correct dose of a drug. The syringe is administered manually the way many shots are typically taken. Prefilled syringes allow you to control the speed of the injection. However, for people with spondylitis that affects the fingers, self-injection with a prefilled syringe may be difficult.

Self-Injection Pens

A self-injection pen is a type of auto-injector that is also prefilled with the appropriate dose of a drug. A self-injection pen has a mechanical spring-loaded needle hidden inside. Some people prefer this method because the needle is not seen. When the device is held against the skin, the needle can be released with the press of a button. For some people, self-injection pens are easier to use than manual prefilled syringes, but they can also cause more swelling, bruising, or pain at the injection site.

One MySpondylitisTeam member reassured another member about auto-injectors. “You cannot see the needle when you give yourself the shot,” they wrote.

Another member, who has been taking a biologic for three years, concurred. “It’s mostly all positive and helps a lot with the stiffness, making for a more comfortable day,” they wrote. “All in all it has been a plus. It is available in an injectable pen and you never see the needle. It can sting but not that bad.”

E-Devices

An e-device is a type of auto-injector that has enhanced technology. E-devices are electronic auto-injectors that are reusable and have a range of functions. Depending on the model, e-devices include features such as the ability to control the speed of injection, logging capabilities to record treatments with the device, and sensors that prevent injection if the device does not have proper contact with the skin. E-devices may be too complicated for some people who may prefer a simpler form of self-injection.

Proper Training for Self-Injection

Talk to your health care provider about having your first self-injection supervised by a trained clinician. You will likely have questions about how to administer the injection properly. It is also important to get clear information about how to store self-injectors, which require refrigeration.

One study of 79 participants with autoimmune diseases, including people with spondylitis, found that proper training for self-injection with the drug Cimzia led to improved confidence and satisfaction with self-injection treatment experiences. Training was found to also build confidence among people with limited dexterity and to help diminish fears related to the use of needles.

Tips and Techniques for Self-Injection

Always follow medical advice from your health care team on the proper self-injection process. The following tips can help make your injection experience easier and can be discussed with a health care professional.

Prepare Carefully

Before injecting, prepare a clean, uncluttered area. Wash your hands and have an alcohol swab handy to disinfect the injection site before administering the injection. Some people like to have a family member, friend, or caregiver with them, especially when first starting self-injection.

Some syringes and auto-injectors can be removed from the refrigerator for an hour or two before they’re used to bring the medication to room temperature. Cold, refrigerated medication may be uncomfortable when injected. Some syringes and auto-injectors can also be warmed with one’s hands before use. Be sure to ask your provider about specific protocols for your particular medication before warming it to room temperature.

Choose the Right Injection Site

Self-injections are usually administered to the arm, abdomen, or thigh. Many people find that the thigh is both easy to reach and the least sensitive to pain. Talk to your doctor about rotating injection sites to avoid any one area becoming sore over time or building up scar tissue.

One MySpondylitisTeam member shared their experience. “I have the new pen so I don’t even see a needle. I also inject into my stomach. So far all has been easy peasy.”

Use Ice

An ice pack or ice cube can help numb the injection site before and after self-injecting to reduce any pain or swelling. Pinching up the skin around the injection site before and during the injection is also recommended to reduce pain.

Possible Self-Injection Side Effects

Injections have a risk of side effects at the site of the injection, whether they are administered by a clinician or self-injected. Common side effects include pain, discoloration, itching, or swelling, but sometimes reactions stop after a few injections. Discuss any injection-site reactions you experience with your health care team to determine if reactions can be minimized.

Treatment with biologic drugs may also cause side effects from the medication itself. Nausea, flushing, or headaches are common. Your health care providers can explain potential side effects associated with biologic drugs.

If you experience an allergic reaction to a self-injection with symptoms such as shortness of breath, itchy eyes, a full-body rash, fever, or chills, contact your doctor immediately.

Talk With Others Who Understand

On MySpondylitisTeam, the social network for people with spondylitis and their loved ones, more than 74,000 members come together to ask questions, give advice, and share their stories with those who understand life with spondylitis.

Do you have questions about self-injection or experiences you’d like to share? Add your thoughts in the comments below, or start a conversation with others on your Activities page.

Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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