IM technique - keep hitting a nerve :-/

[AnIrregularApocalypse]

The Problem
I like to IM 50-60mg (1-1.2ml @ 50mg/ml) of ketamine on occasion. I'm rx'd it, so I've no concerns about the ketamine itself, and of course I always use a new, sterile needle and syringe. So it's as safe as I can make it.

So, if I inject into my deltoid, it's all good - but I need to rotate sites (plus it deltoid IM does hit a little too fast for my liking). But almost every.single.time I inject into my thigh, it feels like I've hit a nerve - I get a sharp pain like electrical fire, and a muscle will jerk involuntarily. Now, I have peripheral small fiber neuropathy, which is basically nerve damage in my legs, and is the reason I'm rx'd ketamine (for constant neuropathic pain) - I'm not sure if this is why this is happening, or if it's simply my technique.

My Technique
I inject into the vastus lateralis muscle, on the outer side of my upper leg - if I flex my leg, I can see the outline of the muscle clearly. I visually divide the top of my leg into thirds, and inject into the middle third, using a 1 1/4" needle, at 90 degrees to the surface of the leg.

What I've Tried

• I've tried going a bit higher and lower in the muscle, but still, around 75% of the time it feels like I hit a nerve. Which is not nice :-/
• I've tried using a 1" needle instead, but it doesn't help - the nerve pain comes at around 3/4" to 1", and depending where on the leg I went for, it can result in subcutaneous injection instead

Advice Please!
Anyone else had this problem? Is there anything wrong with my technique? if I can't figure this out, are there any other good muscles for self-injection of ~1ml (I don't want to do glutes, it seems too awkward, and I'm afraid of damaging my sciatic nerve)?

 

[MsDiz]

Well you have peripheral small fiber neuropathy. Of course you’re going to feel that if you inject. It’s gonna be incredibly hard to not intentionally hit one of the small nerve fibres that are in those areas.

If you’re given ketamine for this, what ROA did they advise? If IM then they should have shown you properly where to go.

 

[OpiateKiller]

I’ve done thousands of IM injections and never use the thigh because it was incredibly painful every time.

I would suggest the glute. It’s hard to fuck up honestly and it’s the best IM injection site. You can go either side and if you draw a cross on each ass cheek it’s the upper outer quadrant. Google will be more helpful. Just don’t go too close to your butt crack or to low.

But I can do a shot into the same side even 2 days later it’s such a wide injection area and it’s painless

 

[AnIrregularApocalypse]

Well you have peripheral small fiber neuropathy. Of course you’re going to feel that if you inject. It’s gonna be incredibly hard to not intentionally hit one of the small nerve fibres that are in those areas.

If you’re given ketamine for this, what ROA did they advise? If IM then they should have shown you properly where to go.

Oral. But I get enough that I can use it "correctly" to help with pain during the day, and occasionally have some fun with it at night.

I would add that chronic pain had me on the verge of suicide before I started on ketamine - my recreational usage is also unofficially medicinal usage, as it does wonders for my mood, even days afterwards. Traditional anti-depressants (TCAs, SSRIs, SNRIs etc) either did nothing or I couldn't tolerate them.

So basically my recreational use is in place of ketamine infusions (which aren't available where I live, except 1000 km away, and at huge cost) - ketamine is a most marvellous drug!

 

[MsDiz]

Oral. But I get enough that I can use it "correctly" to help with pain during the day, and occasionally have some fun with it at night.

I would add that chronic pain had me on the verge of suicide before I started on ketamine - my recreational usage is also unofficially medicinal usage, as it does wonders for my mood, even days afterwards. Traditional anti-depressants (TCAs, SSRIs, SNRIs etc) either did nothing or I couldn't tolerate them.

So basically my recreational use is in place of ketamine infusions (which aren't available where I live, except 1000 km away, and at huge cost) - ketamine is a most marvellous drug!

I feel for you so much, honestly. I’ve had nerve issues and it is just horrible. Have they tried gabapentin/pregabalin on you yet? Pregabalin can be a really good drug for nerve pain and the combination of both is good for serve nerve pain.

With the ketamine, seriously, if it’s the only thing that helps then go easy on it. I would advise you use it only how you’re prescribed and dont go over that amount. You have a greater risk of it damaging your bladder the more you use and the longer you use it. Check @jhjhsdi signature out (the bit at the bottom of his posts) to see what happens when ketamine starts damaging those organs.

If you’ve not tried gabapentin or pregabalin yet definitely get on to your Dr and see if those could help. They have side effects like all drugs do but the nerve pain relief they give is worth it.

I’d imagine glute IM would be the best option but again, I’d say you've higher chances that you could still hit something there too than the norm.

 

[AnIrregularApocalypse]

I feel for you so much, honestly. I’ve had nerve issues and it is just horrible. Have they tried gabapentin/pregabalin on you yet? Pregabalin can be a really good drug for nerve pain and the combination of both is good for serve nerve pain.

Those were the very first things they tried, but both made me feel like I was constantly drunk. Everything I read said these were the best meds for nerve pain, so I even took 3 months off work to see if the side effects would go away, but nope. It was a fucking horrible 3 months, and I still felt like I was pissed all the time, could barely even walk in a straight line. And it didn't even do a fucking thing for the pain! And then coming off the gabapentin... holy fucking hell. I have a 4-week hole in my life where I have no fucking idea what happened - I've got a few flashes of vomiting and feeling like I was dying, but that's it. I've come off long-term prescription opioids before (taken as prescribed, no abuse), and that wasn't fun, but nothing compared to gaba.

I've tried so many things since then. Methadone helped a bit, but after a few weeks it made me really nauseous all the time.

With the ketamine, seriously, if it’s the only thing that helps then go easy on it. I would advise you use it only how you’re prescribed and dont go over that amount. You have a greater risk of it damaging your bladder the more you use and the longer you use it. Check @jhjhsdi signature out (the bit at the bottom of his posts) to see what happens when ketamine starts damaging those organs.

I always read up on anything meds I take, and I asked my neuro about the bladder thing before I started on ketamine. She confirmed what I've read, that it's only going to be an issue if you're taking several grams a day, every day, for a long time. I'm in the region of only 150mg a day, and have no plans to ever take more than that.

Still, I really appreciate you posting that story - it was a sobering read, and the images will surely stick in my head.

 

[MsDiz]

Those were the very first things they tried, but both made me feel like I was constantly drunk. Everything I read said these were the best meds for nerve pain, so I even took 3 months off work to see if the side effects would go away, but nope. It was a fucking horrible 3 months, and I still felt like I was pissed all the time, could barely even walk in a straight line. And it didn't even do a fucking thing for the pain! And then coming off the gabapentin... holy fucking hell. I have a 4-week hole in my life where I have no fucking idea what happened - I've got a few flashes of vomiting and feeling like I was dying, but that's it. I've come off long-term prescription opioids before (taken as prescribed, no abuse), and that wasn't fun, but nothing compared to gaba.

I've tried so many things since then. Methadone helped a bit, but after a few weeks it made me really nauseous all the time.



I always read up on anything meds I take, and I asked my neuro about the bladder thing before I started on ketamine. She confirmed what I've read, that it's only going to be an issue if you're taking several grams a day, every day, for a long time. I'm in the region of only 150mg a day, and have no plans to ever take more than that.

Still, I really appreciate you posting that story - it was a sobering read, and the images will surely stick in my head.

I’m so sorry the gaba/preg didn’t work for you. When prescribing those meds you really need to build them up over weeks. You can’t just put a patient on 300mg pregabalin for example so if your Dr did that then no wonder you had those sides.

I have also come off them both and yes it was absolutely awful but I’ll be honest, they both helped my nerve pain so much and I take them occasionally now if I’m having a bad day. I’m surprised they didn’t help but again if your prescribing Dr wasn’t dosing them correctly then, well...

As for the Ketamine damage, look, yes in people it can take grams worth but there are people where small doses can also cause damage so if you’re having any issue with cloudy urine, urine retention, pain in the lower back, bladder pain etc then please mention it to your dr.

Anyway, if you’re still going to try the IM I would go for the glute. Your glute is broken up into 4 parts, when doing IM the usual spot is either top right quadrant for right buttock or top left quadrant for left. You’ll find good diagrams online. It’s not hard to do.

 

[jhjhsdi]

it was a sobering read, and the images will surely stick in my head.

@MsDiz

 

[Keif' Richards]

Hey there! I have a lot of experience with injecting Intramuscularly, so you're in luck. In general, injections of any kind in the legs or lower are known to produce significantly more complications than injections in the upper body. So you aren't alone in this. I had great veins for years but destroyed them in a matter of days by injecting Methadone take homes. I had a summer job delivering supplies to different wards in a hospital. Everything from gauze to bandaids to IV bags and so on. I would deliver IV kits too. I ended up stealing a couple of intravenous catheters, tubing and a 60ml luer-lock syringe. I went home and put the line in, taped it and injected two full bottles of Methadone fairly easily. I did this less than half a dozen times and no longer had any useable veins because of it. Just thought I would take the time for a disclaimer against injecting Methadone. It's genuinely, very bad for your veins. I went from having great veins from years of practicing good technique to having to have the ultrasound guy come every time I need an IV.

Anyway, this all forced me to use IM as a route of administration. In a clinical, sterile setting, there's not a lot of difference in harm between IV and IM, but there are when you're using under less-than-optimal conditions i.e. injecting street drugs. As a matter of fact, it takes longer for your body to process drugs injected intramuscularly, as the substance will inevitably spend a longer time in the muscle than it would in the vein. This means complications like abscesses and other infections are more likely. This just means you want to be super careful in your technique. Use new rigs, sterilize the area prior to injection and I've found, applying heat followingb injection seems to reduce pain and aid absorption. This last bit is unconfirmed and is really just a matter of opinion based upon my own experience and observation.

As other folks have said, your neuropathy is likely going to make this process more painful than for those without neuropathy. Still, injections into the legs are typically more painful and due to things like gravity and distance from the heart, are more likely to cause complication and pain. The deltoid is typically considered the gold standard in terms of IM sites, but the quadriceps is often used when quick application is necessary. Their large size and thus, easier identification, make them attractive when for instance, administering antipsychotics and/or sedatives to combative patients. But as we have covered, injecting in the legs is known to produce more complications than injections into the upper body.

A major disclaimer here is that what I'm about to say is mostly based upon my experience, not science or research, so please proceed with that in mind. I stopped injecting not long after my veins died, but I did continue to IM consistently for several months. I used the deltoids, biceps, triceps and even my pectoral muscles as I rotated. No matter what muscle group I used in my upper body, it always seemed to be an easier, less painful process than attempting to inject into my quadriceps. I've also injected into my buttocks (the muscle not the rectum) and as sites go, I found that to be the least painful among sites of the lower body. It's worth noting that the buttocks is a common IM site for medical professionals.

Over the course of those several months, I never experienced any issues aside from bruises and lingering tenderness, but I eventually ended up with an abscess on my right biceps, which was more or less my last major event as an addict prior to my quest for sobriety. I had never had an abscess prior to the IM injections, so do with that information what you will. The best thing I can think of as far as a "quick fix" might go, is maybe applying some lidocaine to the area you intend to inject into. I'm really not sure at all how safe it is to do this, but it's the best thing I can think of off the top of my head. Otherwise, you probably will have to grin and bear it when you inject. I know that sucks, but I'm not really sure what else can be done.

Have you tried or though of administering rectally? I always throw this out when I feel people are near the end of their viability for injections. It's my opinion that repeated IM injections of street drugs is often not sustainable. Muscles harden, infections are acquired etc. If you're safe and practice great hygiene, you can surely extend the lifespan of your injection sites, but I still think it is a practice that is usually not sustainable.

 

[AnIrregularApocalypse]

Have you tried or though of administering rectally? I always throw this out when I feel people are near the end of their viability for injections. It's my opinion that repeated IM injections of street drugs is often not sustainable. Muscles harden, infections are acquired etc. If you're safe and practice great hygiene, you can surely extend the lifespan of your injection sites, but I still think it is a practice that is usually not sustainable.

I hadn't considered that, no. I had a quick look, and Wikipedia reckons rectal bioavailability of ketamine is lower than than of intranasal.

I didn't mention this before, but I also sometimes take ketamine intranasally of an evening, actually much more often than IM. I concentrate the ketamine liquid it to around 100-150mg/ml, and put it in a small nasal spray bottle. This is really effective, and means my nose doesn't dry out (which I believe is what causes most of the damage when snorting powdered drugs). It's also much more pleasant that snorting powder! Still though, the bioavailability is around half than of IM. It also takes longer to dose, as I need 6-8 sprays over the course of 20-30 mins, although I usually do actually prefer the slower onset.

 

[OpialiciouslyMe]

Those were the very first things they tried, but both made me feel like I was constantly drunk. Everything I read said these were the best meds for nerve pain, so I even took 3 months off work to see if the side effects would go away, but nope. It was a fucking horrible 3 months, and I still felt like I was pissed all the time, could barely even walk in a straight line. And it didn't even do a fucking thing for the pain! And then coming off the gabapentin... holy fucking hell. I have a 4-week hole in my life where I have no fucking idea what happened - I've got a few flashes of vomiting and feeling like I was dying, but that's it. I've come off long-term prescription opioids before (taken as prescribed, no abuse), and that wasn't fun, but nothing compared to gaba.

I've tried so many things since then. Methadone helped a bit, but after a few weeks it made me really nauseous all the time.



I always read up on anything meds I take, and I asked my neuro about the bladder thing before I started on ketamine. She confirmed what I've read, that it's only going to be an issue if you're taking several grams a day, every day, for a long time. I'm in the region of only 150mg a day, and have no plans to ever take more than that.

Still, I really appreciate you posting that story - it was a sobering read, and the images will surely stick in my head.

That's my experience of gabapentinoids too. Especially pregabalin. Just felt wobbly and dizzy and sleepy. I couldn't be functional like that.
If I use them now it's only for opioid withdrawal or as a sleep aid but that rarely.