Does Pain Level Change When Receiving Multiple Intravitreal Injections?

The aim of this study was to evaluate differences in pain intensity among patients receiving their first and those receiving multiple (≥10) intravitreal injections (IVIs), and to identify demographic, systemic, and ocular factors associated with pain perception.

This cross-sectional study included 86 eyes of 86 patients treated with intravitreal anti-VEGF agents or corticosteroids for retinal vascular and neovascular diseases. Pain was assessed within 5 min after injection using the Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (worst pain imaginable). Patients were grouped according to injection number: group 1 (first injection, n = 19) and group 2 (≥10 injections, n = 67; subdivided into 2a, 2b, 2c).

The median VAS pain score among all included patients was 2 (range 0-10). Median VAS score increased with the number of injections, female sex, and urban residence, whereas it decreased with diabetes, arterial hypertension, and smoking habits. However, multiple regression analysis showed that only female sex (p = 0.038) and a greater number of intravitreal injections (p = 0.020) were significant independent predictors of higher VAS scores, whereas urban residence showed a marginal association (p = 0.058).

Pain intensity after intravitreal injections was generally low but tended to increase with the number of injections. Female sex and a greater number of injections were independent predictors of higher VAS scores, while urban residence showed a marginal association. These findings suggest that patient-related characteristics and cumulative treatment burden may influence pain perception, highlighting the importance of individualized counseling and comfort-oriented strategies during chronic intravitreal therapy.