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RA and injection fatigue


There. I did it. Another biologic DMARD injection for my RA is done, and no more thinking about for another two weeks.

It was easy, as it usually is. What wasn’t easy was the anticipatory build-up, starting at the beginning of the week. I look at the calendar and there, on the box marked THURS, in my breezy handwriting, is “Jab Today, R.” Which means that Thursday is Biologic DMARD Injection Day, and because I’m the forgetful type, the R stands for my right thigh as the injection site. Don’t want to shoot up the same thigh twice in a row.

So, there’s the calendar. Then, every day since Monday, I see the marked THURS again, except now it’s another day closer. I put it out of my mind, but really, I can’t help thinking about it. Because you know what? There is just nothing less natural than positioning a pen-gun on your leg, pressing the trigger, holding it there, and counting to 10 while it fires a needle through your skin, into the layer of subcutaneous fat beneath it, and injects a cold liquid that may–but not always–burn through your nerve endings like a flood of icy fire.

That’s the event I anticipate, with a whirl of fluttering butterflies in my belly, each time I glance at that calendar.

And when Thursday finally arrives? All day I think about it. I could get out of bed and inject first thing in the morning–get it over with–but in the four months I’ve been using this drug for my RA, I haven’t been able to do that. I just don’t have the required steeliness of mind to shoot myself up that early in the morning.

Instead, I tell myself “later.” Like, tonight, before I go to bed. But it stays on my mind throughout the day, a little niggling knowingness: tonight is Jab Night. Maybe it will burn really bad, like that first time I did it, all alone, with no one to show me how or to hold my hand. It brought me to tears, that time, a combination of nerves and shock and yes, some very brief but eye-opening pain. Or, maybe it won’t hurt at all. Since that first time, I’ve learned the technique. I’m methodical, calm, composed, and determined. I’m a veteran.

I get the pen, in it’s packaging, out of the refrigerator, where it lives before injection. I set it on my desk to let it warm up to room temperature. I set the alarm on my phone for 30 minutes. When it beeps, I get up and take an ice pack out of the freezer. I put it on the appropriate thigh–my right one, tonight–and reset the alarm for another 25 minutes. When that’s gone, it’s time. There’s no putting it off, now. You can’t re-chill the medicine. You must use it, or waste it. And no one in their right mind wastes a medicine that costs more than two nights in a four-star hotel.

My right thigh is nicely iced and numb. I wash my hands with antibacterial soap. I go into the bathroom, sit down, bare my leg, open a tiny, one-use alcohol swab and clean the injection site carefully. As I wait for it to dry completely I open the pen’s packaging, take it out, and prepare it for action. I pinch up about an inch of flesh between my thumb and first finger and position the pen on just the right spot. I take a long, deep breath, hold it, blow it out slowly, set my gaze on the opposite wall, and press the button.

And I hisssss… maybe moan a little if it burns, as it sometimes does, and sometimes doesn’t. I never know which it’s going to be. The bright side is that it never burns very long–just five seconds or so, and then it’s over. What remains, as I carefully lift the pen-injector straight up from my thigh and set it aside, is a red pinhole in my skin, blood welling up into a tiny bead. I get the sticky bandage I’ve got ready and put it on over the pinhole. The area around it is exceedingly tender and hurts like a you-know-what if I press on it, so I’m very, very gentle with the bandage.

I’m done. There’s nothing left now but several still-agitated butterflies in my middle. I take the spent pen and put it into the big, red sharps box, my own personal morgue of used biologic DMARD injectors. Amazingly, they’re starting to build up in there; I can’t believe how many times I’ve jabbed myself already. Another four or five times and the box will be full. Of course, by then I should know whether this drug is going to work, and whether I’ll even need a new sharps box.

The pen-injector is made so that I can’t see how much actual medicine is entering my body and absorbed into my bloodstream. It can’t be all that much, since the instructions that come with the pen only counsel you to hold the pen-injector in place for 10 seconds after pressing the button, hearing the loud CLICK and feeling the needle punch through the skin. There can’t be more than a few thimbles-full of clear-as-water liquid hope.

I’ve never had any after-effect from the injection. The site stops being tender within a few hours. In some people, the medicine causes some swelling or bruising around the injection site, but that’s never happened to me. OK, maybe a tiny, painless bruise, but not every time.

And now, the anticipation begins again. In two weeks, on THURS, I’ll repeat this entire ritual, this time jabbing my left thigh. In the meantime, I live in hope that this drug, this medicine that has slowed or stopped the progression of severe rheumatoid arthritis in so many people before me, will do it for me, too. So far, it hasn’t. But these drugs can take a full six months before they start to work, and I have have another five injections to go before then.

Every day I hold onto hope. My RA has gotten much worse over the last 18 months. Some days the pain, fatigue, and disability is worse than others, but I can count on waking up to it every single day…

Unless. Maybe this injection will be the one that turns the tide.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Ken
    5 years ago

    I have been using Cimzia and doing abdomen injections for a few years now. I was previously using a different medication with the pen injector and really did not like pen at all. The Cimzia comes in a syringe co developed by OXO which makes the injection easy. Well easiER considering you still have to stab yourself.

    One tip I can pass on is that when my medication arrives it always comes two in a box. I used to write a R or L and dates on the box, but now I use this system

    The first shot on the box is the right side and the last shot is the left side. Every box. Every time. Makes it easier to remember. For me anyway.

    Good to hear your jabbing fears are gone

  • Wren moderator author
    5 years ago

    Hi, everyone!
    I just wanted to stop by and give you an update on my most recent injection. Many commenters, both here and on’s Facebook page, suggested I try injecting into my abdomen rather than my thighs, saying that it hurt much less for them.

    So, I set aside my heebie-jeebies at the thought of sticking myself there and went ahead and did it. And guess what? It WORKED! There was no burn this time. No pain at all. I’m so pleased and so grateful to everyone who offered me this wonderful advice.

    My dread of jabbing myself has vanished. If you’re still having trouble with it when you inject in your thighs, allow me to suggest trying your tummy instead. It sure worked for me! 😀

  • Nancy McHugh
    5 years ago

    I stopped injecting in alternate thighs because of the extreme pain. Called the Humira hotline and they told me, as a woman, “grab some fat” in your stomach area (no problem there LOL) and inject. Now I don’t dread “Injection Tuesdays” anymore because there isn’t any pain injecting. 🙂

  • Wren moderator author
    5 years ago

    Hi, Nancy!
    OK, it’s official now. Several others, and now you, have told me how much better it will be if I jab my tummy fat (yes, I’ve plenty, too) instead of my thighs, so next time, that’s what I’ll do. I want to be like you and NOT dread injection day!

    I’m so glad you commented. Thanks! And be sure to stop by again and let me know how you’re doing. 😀

  • Nes
    5 years ago

    Your Thursday is my Tuesday. Yesterday was my second shot. I did my first one at the Dr’s office so they watched me…I did not do so well. Hubs gave me my second shot. I am on Humira and the video was pleasant, I will record my own training video with a little more drama! I did not know about the cold part so I will do that next time, here’s to putting on my big girl panties and being able to do it myself one day…and that it works!!

  • Wren moderator author
    5 years ago

    Hi, Nes,
    I think a dramatic training video that shows the reality involved in taking these injections would be great! Don’t forget the tears, the denial, the growing dread as jab date approaches… 😉

    I think letting the drug come to room temp and icing the jab-site really can make a difference. You’ll do just fine.

    Thanks for stopping by and commenting. You go, grrl!

  • Meg Koelzer
    5 years ago

    The anticipation is the worst part. I feel like I’m going to throw up whenever I even think about injecting. My doctor bumped my Humira up to once a week so I now do methotrexate and Humira injections weekly. And I dread them all week long. They really aren’t that bad (okay sometimes they’re bad) but the pain leaves within a few minutes. Why do we dread them so much? I feel your pain, Wren!

  • Wren moderator author
    5 years ago

    Hi, Meg,
    I don’t know why we dread self-injecting so much, but I suspect it’s basically instinctive. The most primitive part of the brain, the amygdala, is the part that responds instantly to fright and pain, circumventing the actual thought processes we normally use. That’s great if we need to fight or run away from danger, but in this instance, it just causes a lot of stress.

    That’s my theory, anyway. 😉

    I’m sorry you have to jab yourself twice (!!) every week, but I hope they’re helping to keep your RA under control and your pain and other symptoms quiet. Thanks so much for stopping by and commenting. Come back soon and stay in touch. 😀

  • Robyn Sanchez
    5 years ago

    I can so relate. I anticipate “shot day” every week for my Methotrexate and every other for my Humira. Yes! That makes 2 shots every other week. My first DMARD injection went in my thigh and I couldn’t imagine ever doing it again. I wanted to cry it hurt so terribly. And… It hurt for a long time! I said I’d never do another one… but of course I want to get better so that’s not an option. So I watched a ton of you tube videos and read and re read comments and suggestions from others and ultimately I tried again. This time I tried in my belly. It hardly even hurt at all. I too, have to keep track of where I injected on my calendar because of my foggy brain. I think about these 6 shots I give myself every month more than I care to admit. I think about them even after they’re over for the week. I loathe them with a passion, but I haven’t had a full blown flare since I started Humira. So while I hate them they are also helping me. I’m not without a zillion side effects but hopefully remission is in my future and yours too Wren!! Good Luck!!

  • Wren moderator author
    5 years ago

    Now that’s a LOT of shots, Robyn! I commend your courage and determination in coping with this most frustrating disease. I watched a lot of videos and read comments, too, before my first shot and frankly, most of the comments, at least, were terrifying. Fortunately, I believe most of them were sorta over-the-top, as my experience has never been as horrible and agonizing as described. In fact, not even near it, even when it does sting now and then.

    I’m going to take your advice, lady-up and try injecting into my belly next time. I do have plenty of fat tissue there! 😉 Do you ice beforehand?

    Here’s wishing you remission and, if not that, then continued slowing and control of your RA, Robyn. Thanks so much for stopping by and taking the time to comment. I appreciate it, and I know that many others will take hope and courage from it, too.

  • Antonia Maritima
    5 years ago

    I understand the butterflies, and the anticipation of pain.

    When I take the injection pen from the refrigerator, I hold it beneath my arm to warm it to my body temperature. There seems to be significantly less pain when it is warm. I consider my injection day successful when I hardly feel the needle.

    I had to stop trading thighs when I developed large painful bruises on my left thigh. Now I keep track of where I injected last time, and pick a different part of my jiggly thigh to jab. It seems to work.

    Remember that you’re not alone, Wren! and Casey, and Andrew. We’re not alone in this awful journey.

  • Wren moderator author
    5 years ago

    Wow, Antonia! Thank you for being so supportive and helpful. It good to know we have fellow jabbers (sorry, ;)) out there who understand the dread. I’ll keep your suggestion in mind–last time, I also got a large bruise on my left thigh, something that hadn’t happened before. It doesn’t hurt, but it’s sure ugly.

    Thanks so much for stopping in and taking the time to comment. Support like this is so important to all of us. 🙂

  • Cassy
    5 years ago

    Thanks for sharing, I too, dread the injection day. I have been doing this for a year. I have seen some improvements. GOOD LUCK! I will keep you in my prayers.

  • Wren moderator author
    5 years ago

    Thank you, Cassy! It’s good to know I’m not alone in this odd phobia. I’ve never really been scared of needles, so that’s not it. But something about doing that injection just gives me the heebie-jeebies. I hope you and I both get to the point where it will just be old hat one day soon.

    Thanks for stopping by! 🙂

  • Andrew Lumpe, PhD moderator
    5 years ago

    Here’s to hoping that the short jab has long term benefits for you!

  • Wren moderator author
    5 years ago

    Thanks, Andrew! 😀

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