How to make a penicillin shot less painful?

October 9, 2025 •

4 min read

Intramuscular (IM) injections of benzathine penicillin G can cause severe pain for many patients, often rating it highly on a pain scale. Fortunately, healthcare professionals and patients can employ several strategies to help make a penicillin shot less painful and improve the overall treatment experience.

Quick Summary

Pain from penicillin shots can be reduced using a combination of techniques applied before, during, and after the injection. This includes local anesthetics, muscle relaxation, distraction methods, specific injection procedures like the Z-track, and effective aftercare such as compresses and movement.

Key Points

Pre-injection Numbing: Apply a topical anesthetic cream or use a cold spray 30-60 minutes before the shot to numb the skin's surface and reduce initial pain from the needle stick.
Lidocaine Mix: Ask your provider about mixing the penicillin with lidocaine, which has been shown to significantly reduce pain scores both during and after the injection without affecting drug concentration.
Relax Your Muscles: For an intramuscular shot, relaxing the muscle is critical. Tense muscles can make injections more painful, so try lying down or finding a comfortable position that keeps the injection site loose.
Utilize the Z-Track Method: This technique prevents medication from leaking back into sensitive tissue, which minimizes localized irritation and prolonged pain. Request that your provider use this method.
Practice Distraction and Breathing: Engage in deep breathing or a distraction technique like talking, using a smartphone, or looking away to manage anxiety and focus your mind away from the injection.
Use Post-Injection Compresses: For initial swelling, apply a cold pack. For soreness that develops after 24 hours, a warm compress can help soothe the muscle.
Take OTC Pain Relief: After consulting your doctor, over-the-counter pain medications like acetaminophen or ibuprofen can effectively manage post-injection soreness and inflammation.

Strategies to Reduce Pain Before the Injection

Proper preparation can significantly reduce the pain and discomfort associated with a penicillin shot. By addressing anxiety and numbing the area, patients can experience a much more tolerable injection.

Use Local Anesthetics and Numbing Agents

Studies show that incorporating a local anesthetic can dramatically lower post-injection pain. The most effective method is for the medication to be diluted with a local anesthetic like lidocaine by the healthcare provider. Always confirm this option with your provider, as it may not be standard practice everywhere. For a self-administered injection, or when a mixed injection isn't possible, topical numbing agents can be used.

Lidocaine or Prilocaine Cream: Anesthetic creams like EMLA or L.M.X.4 can be applied to the injection site 30 to 60 minutes beforehand to numb the skin's surface, reducing the initial needle stick pain. While this is effective for the initial prick, it doesn't address the deep muscle pain from the medication itself.
Cold Spray: Products like ethyl chloride cold spray can be used just before the injection to provide a rapid, though temporary, numbing effect.
Buzzy Device: This device uses a combination of vibration and cold to distract nerves at the injection site, confusing the body's pain signals.

Warm the Medication

If the penicillin medication has been refrigerated, injecting it cold can cause extra pain. A healthcare provider should allow the syringe to warm to room temperature for 20 to 30 minutes before administering the injection. This helps the viscous suspension flow more easily and reduces local irritation.

Relax Muscles and Reduce Anxiety

Muscle tension can make an injection significantly more painful. Fear and anxiety can also heighten the perception of pain.

Find a Comfortable Position: Lying down is often recommended, especially for injections in the buttocks, to ensure the muscle is completely relaxed.
Practice Deep Breathing: Slow, deep breaths can help calm your body and mind. Inhale slowly for four seconds, hold for a moment, and exhale for four seconds. Focusing on this rhythm can be a powerful distraction.
Use Distraction: Engage your mind with something else. Look at a poster, play a game on your phone, or talk to your companion.

Techniques During the Injection

How the injection is performed plays a critical role in pain management. Discuss these techniques with your healthcare provider beforehand.

The Z-Track Technique

This technique involves displacing the skin and subcutaneous tissue to the side before inserting the needle. The tissue is released after the medication is injected, creating a zigzag path that seals the medication deep within the muscle. This prevents the irritating medication from leaking back into the more sensitive subcutaneous tissue, which can cause prolonged pain and nodules.

Slow Administration

Because benzathine penicillin is a thick, viscous suspension, it should be injected slowly and steadily into the muscle. Rushing the injection can increase pressure and cause more pain. A slow injection speed helps the muscle accommodate the volume of medication more gradually, minimizing discomfort.

Distract and Relax

Continue to use distraction techniques during the actual injection. The healthcare provider can also help by engaging you in conversation. For children, techniques like blowing bubbles or using a vibrating toy can be effective.

Aftercare to Manage Post-Injection Pain

What happens after the shot is just as important for controlling lingering pain.

Apply a Warm or Cold Compress

Applying a cold compress or ice pack wrapped in a cloth to the injection site for 10-20 minutes can reduce initial swelling and pain. After the initial 24 hours, switching to a warm compress can help soothe muscle soreness by promoting blood flow.

Stay Active and Mobile

Keeping the body part that received the injection moving can help disperse the medication and reduce muscle soreness. Gentle exercise, such as walking or moving the affected arm, can be beneficial. However, avoid strenuous activity immediately after the injection.

Take Over-the-Counter Pain Relievers

Over-the-counter (OTC) medications like acetaminophen (Tylenol) or ibuprofen (Advil) can be taken after the injection to manage pain and inflammation. Always consult with your healthcare provider to ensure these are safe for you and won't interfere with your treatment plan.

Comparison of Penicillin Injection Pain Reduction Methods


Method	Timing	Best For	Level of Pain Reduction	Requires Professional Help?	Notes
Lidocaine Dilution	During	Immediate and lingering muscle pain	High	Yes	The most effective method for deep muscle pain
Topical Numbing Cream	Before	Initial needle prick	Moderate	No	Does not affect deep muscle pain
Warming Medication	Before	General discomfort	Moderate	Yes	Standard practice to help flow and irritation
Z-Track Technique	During	Preventing leakage and lasting pain	High	Yes	Specialized technique to seal the medication
Relaxation & Distraction	Before & During	Reducing anxiety and perception of pain	Moderate	No	Very effective for fear and muscle tension
Cold/Warm Compresses	After	Swelling (cold), Soreness (warm)	Moderate	No	Easy at-home aftercare
OTC Pain Relievers	After	Persistent soreness and inflammation	Moderate	No	Consult a doctor before taking

Conclusion

Pain from a penicillin shot is a common and valid concern, but it does not have to be an unbearable experience. By proactively communicating with your healthcare provider, utilizing pre-injection numbing and relaxation techniques, and following up with proper aftercare, you can significantly reduce the discomfort. The most effective strategies often involve the healthcare provider directly, such as using a lidocaine diluent or the Z-track technique, so it is vital to discuss your options with them. Combining these methods—from distraction during the process to compresses afterward—can turn a daunting injection into a much more manageable part of your treatment plan. Taking control of the pain management process can not only reduce discomfort but also alleviate anxiety for future injections. For more detailed clinical information on lidocaine dilution, see the Evaluation of Combined Strategy to Reduce the Pain of Penicillin G Benzathine Injection.

Frequently Asked Questions

Penicillin shots, especially benzathine penicillin G, are more painful because the medication is a thick, viscous suspension injected deep into a large muscle. The high volume and consistency of the medication, along with its slow absorption, can cause significant irritation and soreness, unlike the small volume of a typical vaccine.

Yes, you can use a topical numbing cream (like EMLA or L.M.X.4) after consulting your healthcare provider. Apply it to the injection site 30-60 minutes beforehand. It will primarily numb the skin, which helps with the initial needle prick, but will not address the deeper muscle pain caused by the medication itself.

Yes, for certain types of penicillin, it is considered safe and effective to mix the dose with a lidocaine diluent to significantly reduce pain, as shown in clinical studies. This must only be done by a qualified healthcare professional who can confirm it is appropriate for your specific medication and condition.

The Z-track technique is a special injection method where the skin is pulled to one side before the needle is inserted. After the injection, the skin is released, which creates a staggered, zigzag path that seals the medication deep in the muscle and prevents it from leaking into the more sensitive tissue layers.

For immediate pain and swelling right after the injection, use a cold compress or ice pack for 10-20 minutes. After 24 hours, if you have muscle soreness, a warm compress can be more soothing as it increases blood flow and relaxes the muscle.

Yes, after speaking with your doctor, you can take an over-the-counter pain reliever like acetaminophen or ibuprofen to manage post-injection soreness. These medications help reduce inflammation and discomfort at the injection site.

Yes, relaxing the muscle receiving the injection is a proven technique for pain reduction. Tensing up causes the muscle fibers to tighten around the medication, increasing discomfort. Focusing on deep breathing and distracting your mind can help keep your body more relaxed.