title: 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.
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.
authors.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.
authors.forename: Maria Luisa Sánchez
authors.initials: ML
authors.lastname: Masid
authors.forename: Rosalía Horno
authors.initials: RH
authors.lastname: Ocaña
authors.forename: María Jesús Díaz
authors.initials: MJ
authors.lastname: Gil
authors.forename: Maria Concepción Ramírez
authors.initials: MC
authors.lastname: Ramos
authors.forename: Matilde Escutia
authors.initials: ME
authors.lastname: Roig
authors.forename: Maria Rosario Coll
authors.initials: MR
authors.lastname: Carreño
authors.forename: Jaime Cordero
authors.initials: JC
authors.lastname: Morales
authors.forename: Maria Luisa Vergara
authors.initials: ML
authors.lastname: Carrasco
authors.forename: Leonor Mariana Rubio
authors.initials: LM
authors.lastname: Hidalgo
authors.forename: Ana Maria Bernad
authors.initials: AM
authors.lastname: Felices
authors.forename: Adela Harto
authors.initials: AH
authors.lastname: Castaño
authors.forename: Purificación Castañeda
authors.initials: PC
authors.lastname: Romero
authors.forename: Pablo Francoli
authors.initials: PF
authors.lastname: Martinez
authors.forename: Rainel
authors.initials: R
authors.lastname: Sánchez-De la Rosa
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D000068717:Glatiramer Acetate / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007279:Injections, Subcutaneous / Q000295:instrumentation* / Q000451:nursing*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000451:nursing*; D009339:Needles; D009730:Nursing Assessment; D010147:Pain Measurement / Q000451:nursing*; D010865:Pilot Projects; D012646:Self Administration / Q000295:instrumentation / Q000451:nursing; D012885:Skinfold Thickness
chemical_list: D000068717:Glatiramer Acetate