Dr. Jerôme Coulombe offers practical tips to make injections more comfortable

In recent years, treatments for atopic dermatitis have seen significant advancements, and we now have biologic drugs to treat atopic dermatitis. These medicines are received as a subcutaneous (under the skin) injection. Some patients report no fears or challenges with their injections, but others have expressed concerns about pain or fears around needle injection.

Eczema Society of Canada is here to help! We spoke with Dr. Jérôme Coulombe, a Montreal-based dermatologist who sees both adult and pediatric patients, about his best tips to help with these injections, for patients both big and small.

Dr. Coulombe tells us, “Helping patients feel at ease during injections starts with empathy, clear communication, and small but meaningful choices. By creating a calm environment and adapting to the patient’s needs, we can help reduce fear and make the experience more manageable for everyone, especially those who are anxious or sensitive to needles, no matter their age.” 

We also have good strategies from other areas of medicine, like vaccinations, to help us make patients more comfortable when receiving injections:

• Make the patient comfortable – a comfortable seat and position are crucial for a more comfortable experience and a safer, more accurate injection. For children, allow them to sit on a caregiver’s lap (when safe to do so). Sitting position is always less stressful than lying down.
• Make the experience relaxed and calm – a calm caregiver can help the patient to remain calm. This can mean a low and slow voice, not making the patient feel rushed, and reducing things that could scare the patient. For grown-ups, show the patient the needle or device ahead of time, and explain the process. For kids, minimize the explanations about the technique, reduce the visual of the needle, and be conscious of your wording (minimize words like needle, injection, pain, ouch, among others).
• Answer any questions – before the first injection, let the patient and/or caregiver ask any questions to the prescribing health care provider. Answer parents’ questions when the kid is distracted or out of the room.
• Provide a sense of control – by offering small choices like which part of the body to inject or seeing if they want to hold a comfort item can help reduce anxiety and encourage cooperation.
• Seek support and help – it can also be helpful to have the first injection done by a pharmacist or registered nurse. Many pharmacies will provide this service for a low fee.
• Distract – this can be the most important tip! Sharing a story or talking (e.g. ‘talkthesia’) with the patient may help divert attention away from the injection. Other distractions include using a stress ball or a teddy bear, listening to music, listening to a TV show, playing a video game on TV or the phone, singing with your kid, using virtual reality goggles.

If injections are part of your or your child’s treatment plan, Dr. Coulombe share his go-to tips to help you prepare and manage them with more confidence.

• Using Maxilene cream 4% 30-45 minutes before injection under occlusion
• Using Buzzy (vibrating ice pack) for big and little kids
• Use Bionix ShotBlocker (pain management tool) 
• Using ice application 10 min before injection (e.g. ice pack, pack of frozen green peas)
• Cooling spray while injecting
• Rotate injection sites
• Be sure the medication is at room temperature (less painful and difficult to inject
• Inject slowly
• Use a prefilled syringe to control the speed delivery of the drug in lieu of a stylo (e.g. pen-style injector)

ESC thanks Dr. Jérôme Coulombe, Montreal-based dermatologist, pediatric dermatologist, professor, and ESC board member, for his volunteer contributions to this educational content.

References:

Canadian Paediatric Society, Reduce the Pain of Vaccination in Kids and Teens, 2010.

Health Canada, Pain Management for  Children and Vaccinations; accessed July 10 2025, https://www.canada.ca/en/public-health/services/immunization-vaccines/pain-management-children-guidance-health-care-providers.html

Disclaimer: Information provided in this resource does not constitute medical advice and is not intended to be used as a diagnostic tool.  The information is up-to-date at time of publication. All medications, interventions, and treatment plans have risks and benefits, and it is important that individuals discuss their or their child’s specific health care needs with a qualified health care professional. 

July 2025