In 2008, three years after Natalie Hayden was diagnosed with Crohn’s disease, she was hospitalized with an abscess the size of a tennis ball in her small intestine. Until then, Hayden had been managing the condition with aminosalicylate pills, but it soon became clear the medication was no longer working.

“My gastroenterologist walked into my hospital room and said it was ‘time to break out the big guns’ and that the [pills] were the equivalent of Flintstone vitamins,” she recalls.

Hayden chose the self-injectable, in part because she was working a high-profile job as a news anchor for Wake Up Wisconsin and didn’t want anyone to see her getting an infusion at a clinic.

“I preferred the convenience and privacy — and still do,” Hayden says. “I felt better about icing my thigh for five minutes and taking 10 seconds to self-inject and getting along with my day.”

For the first 10 years, the biologic was painful for Hayden to inject. “I struggled giving myself the injections and would have my husband in the room,” she says. In 2018, though, the medication’s formula was changed to a citrate-free version, which greatly lessened the pain of the injections.

Fifteen years after starting a biologic, Hayden — a patient advocate who chronicles her journey on her blog, Lights, Camera, Crohn’s — can finally say, “Now the shots don’t hurt.”

“It’s pretty much a walk in the park for me,” she says. “I don’t stress about it anymore, and I’m so grateful I don’t have to deal with the liquid-fire pain that I used to dread.”

Some people are reluctant to start using self-injectables — which typically come in a prefilled syringe or penlike injector — because they have a fear of needles, says Shubha Bhat, PharmD, a clinical pharmacist at Cleveland Clinic’s Digestive Disease & Surgery Institute.

With Crohn’s injections, “You might feel a little pinch, but it’s not superpainful at all,” she says. In fact, many of Bhat’s patients say they feel surprisingly little pain after using the self-injectable.

“They say, ‘Wow, I only felt a pinch’ or ‘I don’t think I got the medication, because that didn’t hurt,’” Bhat says.

Plus, with the penlike injectors, the needles are hidden, says Andrew Dupont, MD, a gastroenterologist and the director of the inflammatory bowel disease program at The University of Texas McGovern Medical School in Houston. “If you don’t see the needle, that can help with anxiety,” he says.

The hesitancy to start a self-injectable can also arise from what Bhat says is fear of the unknown. “I think there’s a lot of anxiety about what to expect with the process,” she says.

For example, people often wonder how they’ll react to a new medication, how long they’ll have to use it, and how it will affect their lifestyle, says Bhat. “I don’t think there’s great education provided up front when we’re talking about medications in general,” she says.

Hayden can attest to that. “When [you] start a biologic, there’s no telling if the medication is going to help manage your inflammatory bowel disease or if you’re going to have a negative response,” she says.

Most people will be able to give themselves injections without any problems, says Dr. Dupont. “There can certainly be some anxiety initially, but that goes away quickly once you’ve done it a few times,” he says. “Generally, worrying about it is way worse than the actual injection.”

• Ask for a demo. Before you start using a self-injectable, try to connect with a nurse, pharmacist, or even brand ambassador for the medication. They can show you how to administer it correctly, says Bhat. “I have a demo kit in my office, and I will walk a person through how to do the injection,” she says. That way, “They can get comfortable with the device and how it works.”
• Ice the area beforehand. Numbing the skin can make the injection less painful, says Dupont.
• Let the medication warm up to room temperature. If it’s cold, it may feel a little more uncomfortable as it goes into the skin, Dupont says.
• Rotate the injection site. Most people typically give themselves an injection in their abdomen or the front of their thigh, says Bhat. Each time, you should inject the needle into an area that’s at least 1 to 2 inches away from the site of your last injection, which can help keep side effects such as bruising to a minimum.

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  Hayden writes “R” or “L” (for right or left thigh) in her day planner to help her keep track of where she gave her last injection.
• Find something to inspire — or distract — you. When Hayden first started giving herself the injections, she’d look at a photo of her cousin, who’d had two heart transplants and a kidney transplant. “He inspired me,” Hayden says. “Get in a mental space that brings you peace or calmness.” Now, Hayden usually gives herself the injections while watching The Bachelor or The Bachelorette — her guilty pleasure, she says.
• Ask a family member or friend to do it. If you just can’t bring yourself to do it, ask a loved one to do the injection for you, Dupont suggests.
• Recruit some support. Hayden will sometimes invite her children in the room when she gives herself the shot. “My two older kids cheer me on and watch,” she says. “I smile so they see I’m strong through tough moments.”
• Reward yourself afterward. “When it’s all over … have a bowl of ice cream or do something to treat or pamper yourself,” Hayden says. “No matter if it’s painful or not, it’s still not fun.”

Above all, know that giving yourself injections will get easier with time. “The more you do it, the more comfortable you will get with it,” says Bhat.

• Self-injectables for Crohn’s disease tend to be less painful than other injections.
• To take some of the sting out of the injection, let the medication warm up to room temperature and rotate the site with each injection.
• Ask a loved one to support you while you give yourself the injection (or ask them to do it for you).