Needle Anxiety and Injection Site Pain: Evidence-Based Strategies for Patient Counseling on Injectable PrEP

Fear of needles represents a significant barrier for some patients considering long-acting injectable PrEP, but Kevin Hatfield, MD, a primary care and family medicine physician based in Seattle, has developed a comprehensive counseling approach that addresses concerns while setting realistic expectations. His strategy combines transparency about potential discomfort with evidence-based reassurance about the trajectory of the injection experience.

For patients with absolute needle phobia, injectable PrEP simply is not an option, and Hatfield acknowledges this without pressure. However, many patients express hesitation rather than absolute refusal, and these individuals often benefit from education about what to expect. His counseling begins with a crucial reassurance: if patients try injectable PrEP and decide they don't like it, they can always return to oral tablets. This "escape hatch" reduces anxiety about making an irreversible decision.

Setting appropriate expectations about injection site discomfort is essential. In the video above, Hatfield explains that some soreness is normal with any injection—this is simply the body's response to the procedure itself. Most patients report that discomfort is noticeable but manageable, typically lasting only one to two days. He recommends over-the-counter pain relievers like Tylenol or Advil for the day following injection if needed.

One of the most reassuring patterns Hatfield shares with patients is that injection site reactions typically improve with successive doses. Patients receiving their second, third, and fourth injections consistently report less discomfort than they experienced with their first. While the mechanism behind this improvement isn't fully understood, the clinical pattern is clear and helps patients approach their first injection with the knowledge that the experience will likely get easier.

Beyond medication, Hatfield emphasizes the importance of activity following injection. He specifically advises patients not to sit at a desk for six to eight hours after receiving their shot. Movement and activity uniformly improve comfort, so patients receiving morning injections should plan to get up and walk around throughout the day. Proper injection technique by trained staff also contributes significantly to patient comfort, making staff training an essential component of successful implementation.

For more of the conversation with Kevin Hatfield, MD, check out:

• Primary Care Physician Kevin Hatfield, MD, on Barriers to Daily Oral PrEP Adherence
• How Long-Acting Injectable PrEP Reshapes the Patient–Provider Relationship