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A patient care program for adjusting the autoinjector needle depth according to subcutaneous tissue thickness in patients with multiple sclerosis receiving subcutaneous injections of glatiramer acetate.

Masid ML, Ocaña RH, Gil MJ, Ramos MC, Roig ME, Carreño MR, Morales JC, Carrasco ML, Hidalgo LM, Felices AM, Castaño AH, Romero PC, Martinez PF, Sánchez-De la Rosa R - J Neurosci Nurs (2015)

Bottom Line: This was a pilot program performed by MS-specialized nurses in patients with MS new to GA.The needle length setting was selected based on SCT measures as follows: 4 or 6 mm for SCT < 25 mm, 6 or 8 mm for SCT between 25 and 50 mm, and 8 or 10 mm for SCT > 50 mm.The mean SCT ranged from 15.5 mm in the upper outer quadrant of the buttocks to 29.2 mm in the thighs.

View Article: PubMed Central - PubMed

Affiliation: Maria Luisa Sánchez Masid, D.U.E., is an MS Expert Nurse at H. Universitario de Ourense, Ourense, Spain. Rosalía Horno Ocaña, D.U.E., is an MS Expert Nurse at Vall d'Hebrón, Barcelona, Spain. María Jesús Díaz Gil, D.U.E., is an MS Expert Nurse at H. Clínico San Carlos, Madrid, Spain. Maria Concepción Ramírez Ramos, D.U.E., is an MS Expert Nurse at H. Clínico San Carlos, Madrid, Spain. Matilde Escutia Roig, D.U.E., is an MS Expert Nurse at H. La Fe, Valencia. Maria Rosario Coll Carreño, D.U.E., is an MS Expert Nurse at H. Carlos Haya, Málaga. Jaime Cordero Morales, D.U.E., is an MS Expert Nurse at H. Carlos Haya, Málaga. Maria Luisa Vergara Carrasco, D.U.E., is an MS Expert Nurse at H. Carlos Haya, Málaga. Leonor Mariana Rubio Hidalgo, D.U.E., is an MS Expert Nurse at H. Carlos Haya, Málaga. Ana Maria Bernad Felices, D.U.E., is an MS Expert Nurse at H. Clínico de Valencia, Valencia. Adela Harto Castaño, D.U.E., is an MS Expert Nurse at H. Gregorio Marañón, Madrid. Purificación Castañeda Romero, D.U.E., is an MS Expert Nurse at H. Puerta del Mar, Cádiz. Questions or comments about this article may be directed to Pablo Francoli Martinez, PhD, at pablo.francoli@tevaes.com. He is a Medical Science Liason at Medical Department, TEVA Pharma S.L.U., Anabel Segura, 11, Edificio Albatros B, 1st floor, 28108 Alcobendas, Madrid, Spain. Rainel Sánchez-De la Rosa, MD PhD MSc, is the Medical Director and Head of Market Access, Teva Pharma Group, Madrid, Spain.

ABSTRACT

Background: The perceived pain on injection site caused by subcutaneous (SC) self-injection may negatively affect acceptance and adherence to treatment in patients with multiple sclerosis (MS). Pain on injection may be caused by inaccurate injection technique, inadequate needle length adjustment, or repeated use of the same injection body area. However, information is lacking concerning the optimal needle depth to minimize the injection pain.

Objective: The purpose of this program was to characterize the perceived injection-site pain associated with the use of various injection depths of the autoinjector of glatiramer acetate (GA) based on SC tissue thickness (SCT) of the injection site.

Methods: This was a pilot program performed by MS-specialized nurses in patients with MS new to GA. Patients were trained by MS nurses on the preparation and administration of SC injection and on an eight-site rotation (left and right arms, thighs, abdomen, and upper quadrant of the buttock). The needle length setting was selected based on SCT measures as follows: 4 or 6 mm for SCT < 25 mm, 6 or 8 mm for SCT between 25 and 50 mm, and 8 or 10 mm for SCT > 50 mm. Injection pain was rated using a visual analog scale (VAS) at 5- and 40-minute postinjection and during two 24-day treatment periods.

Results: Thirty-eight patients with MS were evaluated. The mean SCT ranged from 15.5 mm in the upper outer quadrant of the buttocks to 29.2 mm in the thighs. The mean perceived pain on injection was below 3 for all the injection sites, at both time points (5 and 40 minutes) and during both 24-day evaluation periods. The mean VAS scores were significantly greater after 5 minutes of injection compared with that reported 40-minute postinjection during both 24-day treatment periods and for all the injection areas. Mean VAS measures at 5- and 40-minute postinjection significantly decreased during the second 24-day treatment period with respect to that reported during the first 24 SC injections for all injection sites.

Conclusions: Our findings suggest that the adjustment of injection depth of SC GA autoinjector according to SCT of body injection areas is suitable to maintain a low degree of postinjection pain. Moreover, our results also may indicate that the use of needle lengths of 6 mm or shorter is appropriate with regard to injection pain for adult patients with MS with SCT < 50 mm.

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Median Pain (and Standard Error), Assessed by VAS, at 5 and 40 Minutes Postinjection During the First (A) and Second (B) 24-Day Treatment Periods in the Dominant and Nondominant Sides of the Injection Body Areas (Arm, Thigh, Abdomen, and Upper Quadrant of the Buttock)
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Figure 1: Median Pain (and Standard Error), Assessed by VAS, at 5 and 40 Minutes Postinjection During the First (A) and Second (B) 24-Day Treatment Periods in the Dominant and Nondominant Sides of the Injection Body Areas (Arm, Thigh, Abdomen, and Upper Quadrant of the Buttock)

Mentions: The mean pain on injection, as assessed by using the VAS diary, was below 3 for all the injection sites, both time points (5 and 40 minutes) and across both 24-day evaluation periods. The VAS score was significantly greater after 5 minutes of injection compared with that reported 40 minutes after injection in all the body areas designed for injection and during the first and second 24-day treatment periods (p < .0001 for all comparisons). The mean VAS scores between the dominant and nondominant sides of the body (regardless of right or left body side dominance) were similar for all the injection sites and for 5- and 40-minute postinjection after the first and second treatment periods (Figure 1).


A patient care program for adjusting the autoinjector needle depth according to subcutaneous tissue thickness in patients with multiple sclerosis receiving subcutaneous injections of glatiramer acetate.

Masid ML, Ocaña RH, Gil MJ, Ramos MC, Roig ME, Carreño MR, Morales JC, Carrasco ML, Hidalgo LM, Felices AM, Castaño AH, Romero PC, Martinez PF, Sánchez-De la Rosa R - J Neurosci Nurs (2015)

Median Pain (and Standard Error), Assessed by VAS, at 5 and 40 Minutes Postinjection During the First (A) and Second (B) 24-Day Treatment Periods in the Dominant and Nondominant Sides of the Injection Body Areas (Arm, Thigh, Abdomen, and Upper Quadrant of the Buttock)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4334306&req=5

Figure 1: Median Pain (and Standard Error), Assessed by VAS, at 5 and 40 Minutes Postinjection During the First (A) and Second (B) 24-Day Treatment Periods in the Dominant and Nondominant Sides of the Injection Body Areas (Arm, Thigh, Abdomen, and Upper Quadrant of the Buttock)
Mentions: The mean pain on injection, as assessed by using the VAS diary, was below 3 for all the injection sites, both time points (5 and 40 minutes) and across both 24-day evaluation periods. The VAS score was significantly greater after 5 minutes of injection compared with that reported 40 minutes after injection in all the body areas designed for injection and during the first and second 24-day treatment periods (p < .0001 for all comparisons). The mean VAS scores between the dominant and nondominant sides of the body (regardless of right or left body side dominance) were similar for all the injection sites and for 5- and 40-minute postinjection after the first and second treatment periods (Figure 1).

Bottom Line: This was a pilot program performed by MS-specialized nurses in patients with MS new to GA.The needle length setting was selected based on SCT measures as follows: 4 or 6 mm for SCT < 25 mm, 6 or 8 mm for SCT between 25 and 50 mm, and 8 or 10 mm for SCT > 50 mm.The mean SCT ranged from 15.5 mm in the upper outer quadrant of the buttocks to 29.2 mm in the thighs.

View Article: PubMed Central - PubMed

Affiliation: Maria Luisa Sánchez Masid, D.U.E., is an MS Expert Nurse at H. Universitario de Ourense, Ourense, Spain. Rosalía Horno Ocaña, D.U.E., is an MS Expert Nurse at Vall d'Hebrón, Barcelona, Spain. María Jesús Díaz Gil, D.U.E., is an MS Expert Nurse at H. Clínico San Carlos, Madrid, Spain. Maria Concepción Ramírez Ramos, D.U.E., is an MS Expert Nurse at H. Clínico San Carlos, Madrid, Spain. Matilde Escutia Roig, D.U.E., is an MS Expert Nurse at H. La Fe, Valencia. Maria Rosario Coll Carreño, D.U.E., is an MS Expert Nurse at H. Carlos Haya, Málaga. Jaime Cordero Morales, D.U.E., is an MS Expert Nurse at H. Carlos Haya, Málaga. Maria Luisa Vergara Carrasco, D.U.E., is an MS Expert Nurse at H. Carlos Haya, Málaga. Leonor Mariana Rubio Hidalgo, D.U.E., is an MS Expert Nurse at H. Carlos Haya, Málaga. Ana Maria Bernad Felices, D.U.E., is an MS Expert Nurse at H. Clínico de Valencia, Valencia. Adela Harto Castaño, D.U.E., is an MS Expert Nurse at H. Gregorio Marañón, Madrid. Purificación Castañeda Romero, D.U.E., is an MS Expert Nurse at H. Puerta del Mar, Cádiz. Questions or comments about this article may be directed to Pablo Francoli Martinez, PhD, at pablo.francoli@tevaes.com. He is a Medical Science Liason at Medical Department, TEVA Pharma S.L.U., Anabel Segura, 11, Edificio Albatros B, 1st floor, 28108 Alcobendas, Madrid, Spain. Rainel Sánchez-De la Rosa, MD PhD MSc, is the Medical Director and Head of Market Access, Teva Pharma Group, Madrid, Spain.

ABSTRACT

Background: The perceived pain on injection site caused by subcutaneous (SC) self-injection may negatively affect acceptance and adherence to treatment in patients with multiple sclerosis (MS). Pain on injection may be caused by inaccurate injection technique, inadequate needle length adjustment, or repeated use of the same injection body area. However, information is lacking concerning the optimal needle depth to minimize the injection pain.

Objective: The purpose of this program was to characterize the perceived injection-site pain associated with the use of various injection depths of the autoinjector of glatiramer acetate (GA) based on SC tissue thickness (SCT) of the injection site.

Methods: This was a pilot program performed by MS-specialized nurses in patients with MS new to GA. Patients were trained by MS nurses on the preparation and administration of SC injection and on an eight-site rotation (left and right arms, thighs, abdomen, and upper quadrant of the buttock). The needle length setting was selected based on SCT measures as follows: 4 or 6 mm for SCT < 25 mm, 6 or 8 mm for SCT between 25 and 50 mm, and 8 or 10 mm for SCT > 50 mm. Injection pain was rated using a visual analog scale (VAS) at 5- and 40-minute postinjection and during two 24-day treatment periods.

Results: Thirty-eight patients with MS were evaluated. The mean SCT ranged from 15.5 mm in the upper outer quadrant of the buttocks to 29.2 mm in the thighs. The mean perceived pain on injection was below 3 for all the injection sites, at both time points (5 and 40 minutes) and during both 24-day evaluation periods. The mean VAS scores were significantly greater after 5 minutes of injection compared with that reported 40-minute postinjection during both 24-day treatment periods and for all the injection areas. Mean VAS measures at 5- and 40-minute postinjection significantly decreased during the second 24-day treatment period with respect to that reported during the first 24 SC injections for all injection sites.

Conclusions: Our findings suggest that the adjustment of injection depth of SC GA autoinjector according to SCT of body injection areas is suitable to maintain a low degree of postinjection pain. Moreover, our results also may indicate that the use of needle lengths of 6 mm or shorter is appropriate with regard to injection pain for adult patients with MS with SCT < 50 mm.

Show MeSH
Related in: MedlinePlus