How painful are Xiaflex injections?

Medically reviewed by Carmen Pope, BPharm. Last updated on Sep 7, 2023.

Official Answer by Drugs.com

Unfortunately, a Xiaflex injection can be a painful process with one study in patients with Dupuytren contracture (DC) reporting 29% of people reporting serious or very intense pain (more than 6 on a numerical rating scale for pain [NRS]), 30% moderate pain (NRS of 4 – 6), and 41% reporting slight or inconsequential pain (NRS 3 or less) during needle insertion and Xiaflex injection (Sanjuan-Cerveró et al., 2016).

The same study also found a correlation between pain during the injection process, and the likelihood of experiencing pain during manipulation, even after administration of a local anesthetic or nerve block. Administration of anesthetic before manipulation (after the injection has been administered) has become routine since 2010 and has been shown to make it easier to manipulate the cord and decrease the number of attempts made to rupture the cord, although it does not influence the outcome of treatment. Out of 135 injections, 57% reported slight or inconsequential pain, 18% reported moderate pain, and 25% reported serious/intense pain despite anesthetic administration and pinprick-insensitive numbness at the fingertips.

The authors concluded that pretreatment anesthesia should be routinely given, despite the prescribing guidelines discouraging its use before injection for DC, saying it (“May interfere with proper placement of the Xiaflex injection’). The authors disagree with this, citing other reasons for neurapraxia reported in the literature, and say these could be minimized by changing the location and direction of the needle placement for retrovascular cords or spiral bands in which the anatomical configuration of the neurovascular bundle has become distorted.

Research has also shown that a “pain memory” – a vivid recollection of the pain during the injection, can influence a person’s decision about whether to complete treatment. In a patient satisfaction survey, more than 23% of patients would not repeat treatment because of concerns about pain associated with the procedure (Bradley & Warwick, 2016).

For Peyronie’s Disease, the prescribing information states that a suitable local anesthetic can be administered before the procedure if desired. Some men report pain during the injection process and for a few days afterward.

References

Brant, W. O., Reed-Maldonado, A., & Lue, T. F. (2015). Injection therapy for Peyronie's disease: pearls of wisdom. Translational andrology and urology, 4(4), 474–477. https://doi.org/10.3978/j.issn.2223-4683.2015.08.09
Brant, W. O., Reed-Maldonado, A., & Lue, T. F. (2015). Injection therapy for Peyronie's disease: pearls of wisdom. Translational andrology and urology, 4(4), 474–477. https://doi.org/10.3978/j.issn.2223-4683.2015.08.09
Sanjuan-Cerveró, R., Carrera-Hueso, F. J., Vazquez-Ferreiro, P., Fikri-Benbrahim, N., Franco-Ferrando, N., & Peimer, C. A. (2017). Pain Associated With Treatment of Dupuytren Contracture With Collagenase Clostridium histolyticum. The Journal of Hand Surgery, 42(2), e109–e114. https://doi.org/10.1016/j.jhsa.2016.11.032
Bradley J, Warwick D. Patient satisfaction with collagenase. J Hand
Surg Am. 2016;41(6):689e697Ralph, D. J., Abdel Raheem, A., & Liu, G. (2017). Treatment of Peyronie’s Disease With Collagenase Clostridium histolyticum and Vacuum Therapy: A Randomized, Open-Label Pilot Study. The Journal of Sexual Medicine, 14(11), 1430–1437. doi:10.1016/j.jsxm.2017.08.015

How painful are Xiaflex injections?

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