For people with moderate to severe psoriasis and psoriatic arthritis (PsA), biologics can be an effective and convenient alternative to traditional treatments like oral medications (taken by mouth), topicals (applied to the surface of the skin), or phototherapy (light therapy). But, as with other psoriasis treatments, injectable biologics sometimes cause side effects — including, for some people, painful or burning sensations at the injection site.

“So, I started my first injections two weeks ago, and believe it or not, I feel maybe 15 percent better. I’m surprised,” wrote a MyPsoriasisTeam member. “I have to do the injection today. Boy, that burns so bad, though.”

In this article, we’ll look at why some people experience pain from injectable biologics, and we’ll suggest techniques to help bring relief.

What Are Biologics?

Biologic drugs are typically used for moderate to severe psoriasis and PsA. Doctors may recommend biologics when topical treatments, phototherapy, and other types of systemic therapy (medication that affects your whole body) don’t control symptoms adequately. There are over a dozen biologics approved to treat psoriasis.

Psoriasis and PsA are caused by an overactive immune system. Biologics target parts of the immune system and block inflammatory proteins that are often responsible for flare-ups.

Biologics need to be administered via injection (a shot into the skin) or by intravenous infusion (through a vein). This is because they consist of large molecules that can’t be properly absorbed when taken orally.

In general, biologics for psoriasis are considered safe and are generally well tolerated. They also offer a level of convenience. Instead of taking medications or applying creams daily, you can inject a biologic less often. Biologic dosing schedules vary — some may be weekly, while others may be every several weeks. Most of the biologics available for psoriasis can be self-injected at home.

However, like any treatment, biologics have potential drawbacks, including side effects like headache, nausea, and an increased risk of infection. Injections can also cause pain at the spot where the shot is administered.

MyPsoriasisTeam Members’ Experience With Biologics and Injection Pain

Pain associated with biologic injections varies from person to person. For some MyPsoriasisTeam members, injections are virtually painless. “There was no pain — I barely even felt the injection,” shared one member. “The first was in my thigh, and the second one I did in my stomach, near my belly button. But, no residual pain even.”

To reduce irritation and pain, rotate among sites from injection to injection.

For others, the pain can be intense — but worth the benefits. “Had such a good few days,” wrote another member. “Injection done for two more weeks. The injections hurt, but well worth the pain lol ☺️.”

Still others find the pain unbearable: “Today, after only four injections, I’ve found out that I have to stop. I’m having a bad injection site reaction, and it’s painful.”

Why Are Biologic Injections Painful for Some People?

Researchers have identified several factors that can contribute to how much pain a person may experience, if any. Factors causing pain include:

• Product-related factors, such as which biologic a person is taking, the dose amount, and the type of injection device used
• Injection-related factors, such as injection technique, temperature of the drug, area of the body where the shot is given, allergens, and frequency of injections
• Person-specific factors, such as low body weight, needle anxiety, allergies, and other health conditions including fibromyalgia and depression

Understanding the three main types of self-injection devices can be helpful, as some can cause more pain than others. Types of devices include:

• Prefilled syringe — This is a syringe and needle. Prefilled syringes offer more control over how quickly you inject a drug, but they can be difficult to manipulate if you have limited function in your hands.
• Self-injector pen (also called an autoinjector) — This prefilled pen has a hidden spring-loaded needle that’s released with the push of a button when the device is pressed against the skin. These devices are easier to use than syringes, but they may cause more swelling, bruising, or pain.
• E-device — This is a reusable autoinjector that offers enhancements like the ability to control injection speed and to stop an injection if the device isn’t in correct contact with the skin. These features can help reduce the pain that might occur with less sophisticated autoinjectors, but they’re also more difficult to use.

7 Ways To Reduce Pain From Biologic Injections for PsA

Although some factors contributing to site pain may be beyond your control, you can try various techniques to reduce pain associated with injecting biologics.

1. Let the Drug Reach Room Temperature

It’s important to keep your biologic medications chilled. You should read the product label or speak with your pharmacist to find out the proper temperature, but the standard is usually between 35.6 and 46.4 degrees Fahrenheit (2 to 8 degrees Celsius).

Fortunately, you don’t need to inject the biologics at a chilled temperature, which can cause pain. Generally, 30 to 45 minutes is enough time to safely let your biologics reach room temperature — don’t use any direct heat sources to speed up the process.

“Try using an ice pack first on the area you’re going to do the injection.”

— A MyPsoriasisTeam member

Speak with your healthcare provider or pharmacist, or read the medication’s warning label, to determine how long you can keep your particular medication out of the refrigerator.

2. Numb the Site

Icing the injection site before or after the shot may reduce some of the pain. “Try using an ice pack first on the area you’re going to do the injection,” one MyPsoriasisTeam member recommended.

You may also consider applying an over-the-counter topical analgesic, such as lidocaine cream, both before an injection and five minutes after an injection.

3. Hone Your Injection Technique

Technique matters when you (or a caregiver) administer your injection. Make sure a doctor or nurse demonstrates how to give yourself your shot. One report from Dermatology Times found that people performed self-injection better and were more satisfied when they had training and education materials.

If you’re using a prefilled syringe, researchers recommend orienting the device at a 45-degree or 90-degree angle and using a skin-pinch technique: pinching a 2-inch fold of skin between your thumb and index finger. Make sure the skin covers the needle completely.

For an autoinjector, administer the shot at a 90-degree angle to the skin.

4. Rotate Among Injection Sites

It’s important to select the proper sites for subcutaneous (under the skin) injections. These areas should have a layer of fat between the skin and the muscle. Parts of the body with these layers include the:

• Top of the thigh
• Outer surface of the upper arm
• Abdomen (excluding the navel and waistline), although especially thin individuals should avoid injecting into this area
• Buttocks, although this area likely isn’t practical for self-administration

Researchers report that injections in the thigh are more painful than those in the abdomen. “I find that doing them in the stomach doesn’t cause me any discomfort or bruising,” one MyPsoriasisTeam member shared.

To reduce irritation and pain, rotate among sites from injection to injection. “I rotate between my stomach and thighs. The thighs sting more,” shared another member.

5. Practice Relaxation Techniques

About 10 percent of Americans have serious injection anxiety. Some people anticipate a shot will be painful, which can influence how much pain they experience.

Cedars-Sinai recommends relaxation techniques, such as deep breathing or visualization, to help reduce shot-related anxiety. According to a couple of other small studies published in The Clinical Journal of Pain, coughing twice (without moving your arms) or inhaling deeply and then holding your breath while you get your shot may help.

6. Ask for Help

As noted, technique matters when injecting biologics. Symptoms from PsA (such as joint pain) or other conditions (such as shaking or vision problems) can make it difficult to use the best techniques when giving yourself a shot.

This may be less of an issue if you use self-injection pens because they don’t require as much finger dexterity. The problem with self-injection pens, though, is that they’re more likely to cause swelling, bruising, or pain — in part because you can’t control how quickly the drug is being administered.

Regardless of what injection device you have, consider asking a friend or loved one for help. Alternatively, you could go to a clinic where a healthcare professional can administer the shot, although this approach can be more expensive and time-consuming.

7. Talk to Your Doctor

If you’re experiencing intolerable injection-related pain, your doctor may be able to help. They can:

• Determine whether you’re administering the drug properly and help perfect your technique
• Suggest ways to reduce discomfort beyond the strategies listed above
• Prescribe an alternative injection method, such as a self-injecting device if a prefilled syringe isn’t working for you
• Adjust your dosing amount or frequency

Other options your doctor might consider include prescribing an entirely different biologic or a different formulation of your current biologic. Drug companies in recent years have released versions of biologics free of a chemical called citrate. The chemical helps drugs maintain their stability but has been linked to injection-related pain.

Find Your Team

On MyPsoriasisTeam, people share their experiences with psoriasis, get advice, and find support from others who understand.

How do you deal with pain from biologic injections? Let others know in the comments below.