How to Reduce Pain After an Intramuscular Injection

Most of the pain from an intramuscular (IM) injection can be managed with a handful of straightforward strategies, some applied before the needle goes in, some during, and some in the hours and days afterward. In studies tracking IM injection pain, roughly four out of five people report at least some discomfort, but it tends to peak right away and fade back to baseline within a few days. The encouraging part is that research has identified specific techniques and simple physical interventions that meaningfully cut both the sharpness of the initial sting and the lingering soreness that follows.

How Long the Pain Typically Lasts

Setting expectations helps. A study following 168 testosterone undecanoate injections found that pain peaked immediately after the needle, reached only moderate severity at worst, lingered for one to two days, and returned to baseline by day four. The pain rarely required painkillers and caused minimal disruption to daily routines. Men who had experienced a painful injection previously tended to report worse pain at the next one, while older and heavier individuals reported less.

What the Person Giving the Shot Can Do

If you have any say in how or where your injection is given, a few variables are worth knowing about. None of them require special equipment; they are simply choices the clinician makes before and during the procedure.

Site selection matters. The ventrogluteal site, which sits on the side of the hip rather than the more traditional upper-outer buttock, has been linked to less injection pain. A systematic review and meta-analysis found a meaningful reduction in pain when the ventrogluteal site was used instead of the dorsogluteal site for gluteal injections performed with the air-lock technique.¹ The deltoid muscle in the upper arm remains the most common site for vaccines, but for larger-volume medications that go into the glutes, asking about the ventrogluteal approach is reasonable.

The Z-track method is another technique clinicians can use. Instead of inserting the needle straight into relaxed tissue, the skin and subcutaneous layer are pulled to one side before the needle goes in, then released afterward. This displaces the tissue layers so the needle track seals off, reducing leakage of the medication back up through the skin. An early nursing study found that Z-track injections produced less discomfort and fewer tissue lesions than standard technique.² A more recent trial testing Z-track with intramuscular diclofenac found that it clearly reduced drug leakage but did not significantly lower pain scores compared to standard injection.³ The technique seems most useful for irritating medications where keeping the drug deep in the muscle, and out of the skin, prevents the burning and stinging that would otherwise develop.

Injection speed is one of those variables where the evidence is genuinely inconsistent. A study giving hepatitis B vaccine to 50 workers at two different speeds found no difference in perceived pain between the slow and fast injections.⁴ But a trial of intramuscular methylprednisolone (a steroid) found that slower injection over 30 seconds produced significantly less pain than a faster 10-second push, and the pain resolved sooner too.⁵ Interestingly, a randomized trial in infants found the opposite: faster injection of a combined vaccine resulted in lower pain scores than slower injection.⁶ The upshot is that “go slow” may help with thick or irritating medications like steroids, where the tissue needs time to accommodate the fluid, but for a quick half-milliliter vaccine, getting it over with fast seems equally good or even better.

Pressure, Cold, and Vibration at the Injection Site

Before the needle goes in, applying firm manual pressure to the injection site for about ten seconds can reduce pain. A controlled trial measured this directly and found a meaningful drop in pain scores on a 100-point scale when pressure was applied beforehand compared to no pressure.⁷ The mechanism is simple: stimulating the pressure-sensing nerves in the skin competes with the pain signal from the needle, dampening what reaches your brain. You can do this yourself by pressing firmly with a thumb or fingertip just before the clinician administers the injection.

Applying cold to the site, such as holding an ice pack or wrapped ice cube against the skin for a few minutes before the injection, also has support. A systematic review examining cold application in adults receiving IM injections found that multiple studies, including both quasi-experimental and randomized controlled trials, reported significantly lower pain in groups that received ice or cold packs before injection compared to control groups.⁸ One caveat: cold does not always help with post-injection soreness that develops over the following days. A randomized trial of patients receiving corticosteroid injections in the hand or wrist found no benefit from ice packs applied after injection when measured over the five days that followed.⁶ Cold seems best suited to numbing the initial sting rather than treating the deeper soreness that develops afterward.

Then there is the Buzzy device, a small vibrating gadget shaped like a bee that is placed on the skin near the injection site, often with an attached ice pack. It works on the same gating principle as manual pressure but adds vibration and cold simultaneously. A meta-analysis found that the Buzzy device produced a large, statistically significant reduction in self-reported, parent-reported, and observer-reported procedural pain compared to no intervention.⁹ A separate systematic review and meta-analysis focused on children during IM injections confirmed those findings, with moderate-certainty evidence for reduced self-reported pain and some benefit for fear and anxiety as well.¹⁰ Studies in adults have also been encouraging.¹¹ The device is inexpensive and reusable, and some pediatric offices now keep them on hand for childhood vaccinations.

Moving and Massaging the Area Afterward

Once the injection is done and you are back home, the instinct to baby the sore arm or hip is natural but probably counterproductive. Gentle movement of the injected limb appears to help, though the evidence is still developing. A case report on gentle upper-limb exercises after COVID-19 vaccination documented reduced pain and redness following a simple exercise routine.¹² Two randomized controlled trials in adolescents and young adults found that exercise after vaccination reduced the number of days participants experienced tenderness, swelling, and fever. In one of the two studies, female participants who exercised also used less pain medication.¹³ A third trial, however, found no significant difference in vaccine-related pain between exercisers and controls, though it did note a trend toward women reporting more pain regardless of group.¹⁴ The overall picture suggests gentle activity is more likely to help than hurt, even if the benefit is modest.

Massage is another option that has direct support. A study comparing pain perception with and without post-injection massage found significantly lower pain scores at five minutes, 30 minutes, and one hour when the injection site was massaged.¹⁵ Light circular rubbing of the area for a minute or two after the shot is easy to do and costs nothing. Research in neonates has also compared local heat application (such as a warm compress) against massage for reducing pain from vitamin K injections, and both methods worked, with local heat performing slightly better.¹⁶ A warm cloth or heating pad applied intermittently to a sore injection site in the hours afterward is a reasonable approach, particularly when cold is no longer needed to blunt the immediate sting.

Pain Relievers and Numbing Creams

Over-the-counter pain medications like acetaminophen and ibuprofen are the most commonly used remedies for post-injection soreness, and for good reason: they work for general pain relief. In the context of vaccination specifically, prophylactic acetaminophen taken before or just after an injection has been shown to reduce local and systemic side effects. A study embedded in a Phase 1/2 trial of the Oxford/AstraZeneca COVID-19 vaccine found that participants who took acetaminophen prophylactically had significantly lower odds of experiencing pain, fever, chills, muscle ache, headache, and malaise in the first two days.¹⁷ That said, a systematic review of pharmacological interventions for needle procedure pain found that the evidence for acetaminophen and ibuprofen reducing the pain of the needle stick itself, as opposed to the soreness that develops later, was not strong.¹⁸ In other words, popping a pill will not make the needle hurt less in the moment, but it can take the edge off the aching and stiffness that follow.

Topical numbing creams are a different story and do reduce the actual needle pain. EMLA cream, which contains lidocaine and prilocaine, significantly reduced both the pain of needle puncture and the pain of the intramuscular infiltration itself in a placebo-controlled trial.¹⁹ A second controlled trial testing EMLA before influenza vaccination confirmed the same finding: less pain at needle puncture and less pain from the injection itself compared to placebo.²⁰ The catch is practical: EMLA needs to be applied at least 30 to 60 minutes before the injection and covered with an occlusive dressing, which makes it awkward for walk-in vaccinations. It is more realistic for scheduled injections, especially for people who receive regular IM medications and know exactly when and where the shot will go.

Whether Painkillers Affect the Immune Response to Vaccines

This is the concern that makes many people hesitate to take ibuprofen or acetaminophen around vaccination time. The worry is that by dampening inflammation, painkillers might also blunt the immune response that makes the vaccine work. The evidence is reassuring but worth understanding in detail. A review of observational studies and clinical trials concluded that antipyretic use around immunization generally did not affect antibody responses. A small number of randomized trials did find slightly reduced antibody levels when painkillers were used prophylactically, but the clinical significance of this reduction was unknown, and the effect was limited to primary vaccination with brand-new antigens; it disappeared after booster doses.²¹ In the AstraZeneca COVID-19 vaccine trial mentioned earlier, prophylactic acetaminophen reduced side effects without affecting immunogenicity.¹⁷ The practical takeaway: taking a painkiller after you start feeling sore is fine. If you prefer to take one before the shot to get ahead of the discomfort, the evidence suggests the risk to your immune response is minimal, particularly if you are getting a booster rather than your first-ever dose of a given vaccine.

What Doesn’t Actually Help

A few commonly suggested tricks have been tested and failed to hold up. Freezing the needle before injection is one. A controlled study comparing cold needles to room-temperature needles found no difference in pain scores for either influenza vaccine or saline injections.²² A broader systematic review of measures for reducing injection pain in adults echoed that conclusion, finding that neither freezing needles nor warming vaccines was effective.²³ One smaller study did report reduced pain with cold needles, so the occasional online recommendation is not entirely fabricated, but the weight of the evidence points against it as a reliable strategy.²⁴

The osmolality of the injected solution, meaning how concentrated its dissolved particles are, has also been investigated as a driver of that burning sensation some injections cause. A controlled trial testing vaccine suspensions of varying osmolalities found no dose-effect relationship between concentration and pain or burning.²⁵ If a particular injection burns, it is more likely driven by the drug’s pH or its chemical properties than by how concentrated it is. There is not much you can do about either variable, since those are determined by the manufacturer, but a review of injection formulations has noted that solutions with a pH close to the body’s natural level and an osmolality below a certain threshold tend to produce the least irritation.²⁶

Distraction During the Injection

Distraction sounds like a soft intervention, the kind of thing people recommend when they do not have anything better to offer. But for IM injections, it has been tested head-to-head against no intervention and performed surprisingly well. A randomized controlled trial gave adults receiving intramuscular benzathine penicillin, a notoriously painful injection, either virtual reality goggles, distraction cards with visual puzzles, or standard care. The control group averaged a pain score of about 6.7 out of 10. The distraction-card group dropped to about 4.4, and the virtual-reality group to about 4.9, both statistically significant improvements. Satisfaction scores told an even starker story: the VR group rated satisfaction at roughly 8 out of 10 compared to about 3.6 in the control group.²⁷ You do not need a VR headset to benefit. Engaging conversation, watching a video on your phone, or focusing intently on a breathing exercise all recruit the same attentional resources. The key is that your brain has limited bandwidth for processing sensory input, and filling that bandwidth with something other than the needle leaves less room for pain signals to register.

Children tend to respond to distraction even more reliably than adults, which is why many pediatric clinics now use bubble-blowing, cartoon screens, or the Buzzy device mentioned earlier during vaccinations. For adults who receive regular IM injections for chronic conditions, building a personal distraction routine, something that is genuinely absorbing and easy to deploy in a clinical setting, can make a real difference over dozens of injections.

Putting a Routine Together for Repeat Injections

People who get IM injections on a recurring schedule, whether for hormone therapy, allergy desensitization, long-acting psychiatric medications, or B12 supplementation, have the advantage of being able to refine their approach over time. A practical combination based on the evidence above might look like this: apply EMLA cream under an occlusive dressing an hour before the appointment; ask the clinician about ventrogluteal placement if the injection is going into the glutes; use firm manual pressure on the site for ten seconds just before the needle goes in; have a phone loaded with something distracting; and plan gentle movement and light massage of the area for the rest of the day. For vaccines specifically, acetaminophen taken after the injection can reduce the next-day soreness and general malaise without meaningfully compromising the immune response. Stacking multiple small-effect strategies is perfectly reasonable, since the mechanisms are different and unlikely to interfere with each other. Over time, comfort with the process also grows, and familiarity itself becomes a form of pain management.