Injection painkiller for children and adults?

[Jim Keane]

Is there a topical aneasthetic for use with children during injections?  I have in mind a dauber type device with a porous pad under stopper with the material in a bottle.

Jim Keane.

[tc3]

Hi,
My son has been recently diagnosed (Apr04, he's 3 yrs old) and I like your ideas for pain/numbing of sites, but is there anything we can do to improve the skin condition of injection sites?  He's already getting rough, bumpy spots on his arms and bottom.  We do rotate very well to all possible sites, but, invariably, the back of the arm gets "overused".  Does anyone know of any creams or soaps, other than normal skin moisturizers?

Thanks,
Tony

[JDRF-Team-LRS]

Hello Jim,
I'm not a physician, but a long time diabetic.

Here are a few ideas to consider to ease the comfort of your child.  Sometimes that "pain" is not really the pain of an injection, but rather the pain of fear and intimidation and sadness that a syringe triggers.

On the physical side, you might consider an ice cube applied to the injection site.  This will both numb the area briefly and also cause the little capillaries to constrict so there's less likely to be even a tiny dot of blood at the injection site.

There are injector devices that cause the injection to be very rapid... the way nurses give us flu shots, etc.  I've never been able to inject myself quickly and I yet I've read that not only is it less painful to do so, but it causes less trauma to the site.  If you or the child's mom is injecting, try to use a quick, smooth motion.  Also consider using an insulin "pen" device.

Be sure you're using the smallest needles possible.  For insulin syringes the larger the "gauge" the smaller the needle.  For syringes, there are 28 gauge needes (BD MicroFine 4); and for pens there are 31 gauge needles (BD UltraFine 3).  Today, there are syringes that are designed for very low dosing that children often need for a while; there are pens also designed with kids in mind.

As soon as your child is even close to old enuf, I'd encourage you to involve him/her in the injection process.  S/he can likely push the plunger before being able to do the injection, but every step of involvement and empowerment will take some of the pain away.

I did a little websearching on "topical anaesthetic" looking for non-commercial sites that had some objective information on products.  One product, I remember being suggested for pump users who are getting adjusted to inserting the cannula.  I haven't used it, but here's the info about EMLA cream which is available in US by Rx only:  http://www.emla-us.com/facts/

At the Walgreen Pharmacy website, there were products that contain topic pain relievers intended for burns, etc. that might work "pre-injection":  ask the pharmacist about Activ Burnstuff Pain-relieving cream that has these active ingredients: Benzethonium Chloride 0.15% , Lidocaine 2.0%; or Bactine with active ingredients: Benzalkonium Chloride 0.13%, Lidocaine Hydrochloride 2.5%

Hope this is helpful.  Be sure to talk with your child's endocrinologist as you consider these options; s/he may have some preferences and/or cautions related to particulars of your child.  Good luck and do check back...

[JDRF-Team-gg]

Hi Jim!  I am a volunteer with JDRF, and just like LRS, not a medical professional so any information that I pass on to you should always be verified first with your child's healthcare team.  I am the Mom of a 17 year old girl who was diagnosed at the age of 21 months, so I have been through what you are experiencing right now.  Knowing that they will be doing shots until a cure is found, you don't want them having to experience any more pain than necessary.  With my daughter, her endocrinologist recommended the use of EMLA and it worked very well when we were trying a new injection site.  Depending on the age of your child, even if this is used as a psychological tool, it's nice to know that there is something available that works well at both numbing the skin and calming the child.  It needs to be applied and stay on the skin for approx. 20-30 minutes prior to injection though. This was the only drawback that we experienced with this prescription. I introduced the EMLA with the understanding that once my daughter became more comfortable with the new site, we would not need the EMLA anymore.  You don't want to create a crutch for something that is a "niceity", not a "necessity".  In our experience, when my daughter was old enough to do her own shots (don't force this issue AT ALL...they need to be ready for this responsibility...it needs to be their idea, not the parents), we tried the pen and with it's shorter needle it was a great way to inject insulin, not to mention that they came in cool colors that kids really liked.  I hope that you are considering the pump at some time in the future also.  My daughter has had hers for 2 years and really loves it.  Endo's are OK'ing this for kids, younger and younger all the time.  There are several manufacturers that you can check out on the web and request information.  You can also come here with specific questions you may have.  I hope I have answered your questioned and helped you out in some way.