Easing the stress of injections.

Giving yourself a shot can be a pain in the butt--or the arm or the thigh. Of course, I'm grateful that drugs are now available to help reduce severity and slow down progression in relapsing types of MS. However, if you're like me, you know how counterintuitive it is to stick yourself with a needle.

As both a person with MS and a psychotherapist who counsels other people with MS, I know that many people dread the shots, despite understanding the benefits of treatment.

So what can be done to take some of the sting out?

Choice comes first

Which medication will work best for you? Some people find that they would rather take an intra-muscular injection weekly and be done with it. Others prefer the more frequent and typically less painful subcutaneous injections. You and your doctor should discuss your options.

Set the scene

If injections make you anxious, create a ritual. Designate a place where you always take your shot. Be sure the area is warm and well lit. You may want a room where you can lock the door so that no one can barge in just as you've gotten up the nerve to go for it.

Pick a time

Evenings are often best because you can sleep through the worst of the side effects. However, some people are too tired at night and prefer to do it earlier in the day. Choose a time that works best for you--and stay with it. I take my weekly injection on Sunday nights because I don't generally work on Mondays. This way, if I feel lousy the next day, I can take it easy.

Unwind yourself

Listening to soothing music, lighting candles, and taking a few deep calming breaths can help you unwind. Some people benefit from a short form of guided imagery to relax the area they are about to inject. They might say, "I see my muscle relaxing ... I feel my warm breath going into the muscle ... I feel calm and confident and I'm grateful to have this healing treatment enter my body." Our thoughts are what make us anxious, so it stands to reason that they can just as easily be used to help us relax.

To lighten her mood before a shot, my friend Marie routinely sings the Cowardly Lion's line from the Wizard of Oz: "Yeah it's sad, believe me, missy, when you're born to be a sissy ... if I only had the nerve."

Master the needle skills

The more confident we are of our injection skills, the less nervous we will be. If you have any doubts about your technique, call your doctor's office or the patient support program offered by your drug company, and review the procedure.

One of the best tips I got is to use the smallest needle necessary. The standard needle in the Avonex package is long enough to go through any amount of fat to reach the muscle. I don't have much fat, so I'm able to get away with a 25-gauge 1-inch needle. Check with your doctor to see if a smaller needle is appropriate for you. You can simply exchange the larger needle for the smaller one when you are prepping.

Get ahead of pain

Taking acetaminophen or ibuprofen a few hours before your shot can reduce both pain and flu-like effects of the interferons. If your medication is refrigerated, taking it out a few hours beforehand can reduce the burning sensation. Icing the site before the shot also lessens pain.

Support is good

After 10 years of injecting myself, I finally gave in and asked my husband to relieve me. I wish I had done this sooner. When he injects me in the arms it gives my thighs a welcome reprieve. People with needle phobias may always prefer to have someone else inject them. I have clients whose neighbors and spouses learn to administer shots. You may also want to ask your patient support program about push-button auto-injectors.

Reward yourself

You are doing what you can to put the brakes on your disease! You deserve a reward. On my shot days, I ask my spouse to make dinner, or I have a video ready that I want to watch. I've earned it.

Allison Shadday, LCSW, is a psychotherapist who was diagnosed with MS in 1994. Her book, MS and Your Feelings: Handling the Ups and Downs of Multiple Sclerosis, will be published by Hunter House later this fall.