Hi, Dr. Adam Goldman with the Metropolitan Vein and Aesthetic Center. I would like to discuss sclerotherapy, a treatment for spider veins, with you further today. I spoke earlier in a previous video about some vein basics, including how to prepare, what to expect, and aftercare. Today, I wanna talk about strategies to minimize discomfort. Unfortunately, this is likely the most uncomfortable aspect of the vein treatment process. I’d like to discuss your options and the best strategy to minimize discomfort during the procedure. 00
Pre-Treatment Pain Management with Analgesics
So, the first thing you could do is take some tablets or analgesia before you come. So you could take Tylenol, Advil, Motrin, let’s say, about two to four hours before you come.
I would take some higher doses. Let’s say it’s Tylenol. I would take five-milligram tablets, two of them before you come, or let’s say Advil or Motrin, which are available over the counter in 200-milligram tablets. You could take three or even four of those. If it upsets your stomach, try eating before taking the medication. This will also help provide some analgesia or relief from the discomfort. While we’re doing the injections. It will not completely resolve it. However, it will help somewhat and is certainly worth a try.
Injection Sensation and Psychological Discomfort
The next thing is that the injection is done with a very small needle, 30 gauge. It feels like a mosquito sting. However, one sting is usually very tolerated. If it continues, which we often have to do, it can become a little uncomfortable. And usually, what happens is that people start to build up anxiety while they’re doing the injections.
So, they start to anticipate things even before they’ve happened. The actual injection only takes a second, and they feel the pinch, and then the numbing begins because the sclerosing solution is mixed with an anesthetic. However, in people’s minds, this becomes a sort of feedback loop, and they get more and more uncomfortable, and it gets very hard for them to tolerate the injections. So the most important strategy is to help calm the mind even before you’ve started and continue that process while we’re injecting.
The Power of Breathing Techniques
And that will make it much easier to tolerate. And the strategy actually is using our breath. Therefore, a breathing technique can help minimize anxiety and assist you in getting through the process. When we breathe slowly through our nose, it actually activates our parasympathetic nervous system. This is contradictory and will slow down the effects of our sympathetic or adrenaline-driven fight-or-flight nervous system.
When that is activated, we feel very anxious. We feel very uncomfortable, and it becomes very difficult to continue with the injections. So, what I recommend to people is to take some nice cleansing breaths even before we’ve started anything. The idea is to take a deep breath in through your nose and then breathe out through your mouth at the beginning. You can use a four- or five-count to do this.
And I would do that four or five times to start the process. Ideally, you wanna breathe in and out through your nose throughout the procedure, and this will help keep us calm. So you breathe in for 4, 1, 2, 3, 4, and then out 4, 3, 2, 1. You just count quietly to yourself while you’re breathing.
Mental Focus and Body Awareness
Now the next step is that while you’re doing these breathing techniques is you kind of wanna start to clear your mind. ’cause If you start thinking about the injections, what’s happening next, you’re gonna get caught up in that. And that’s to be very hard to continue.
So, what you want to do is focus on your breath. You may want to notice how it feels to be warm when you come in and may feel the expansion of your chest. These are techniques that are used in yoga and meditation. They’re very effective. So, what you want to do is start with breathing, clear your mind, and really focus on that breath.
And then the next part is to really start observing. So you start to notice the weight of your hands. You want to relax your face; your jaw just kind of feel yourself on the table itself. And then, when the injections actually start, start to notice it. So as you’re breathing in slowly through your nose and out through your nose, you may feel that pinch, you wanna acknowledge it, notice it, but then kind of let go of that feeling.
You don’t wanna hold onto that emotion of anxiety, of fear, of anger, of discomfort. Just notice it, acknowledge it, and try to let it go. And each time you take a deep breath in, you’re gonna breathe in some more energy. You, as you let go and breathe out, you let go of some of that emotion, and that’s gonna help you feel more calm.
Universal Benefit of Breathing Practice
Now it seems like this is a little basic, however, it is very effective and it’s something you can apply to your entire life. So anytime you’re feeling anxious or not calm, or you hear some bad news, or things are feeling a little unsettled, taking deep breaths in and out through your nose is very effective.
Topical Anesthetic Cream (BLT)
The last strategy is an actual topical anesthetic cream. The most common is called BLT, and it’s not. The sandwich is a combination of benzocaine, lidocaine, and tetracaine. These three different anesthesia anesthetics are mixed together because they each have different properties.
The first, the benzocaine, is observed very quickly and provides a fast numbing effect. Lidocaine produces a deeper effect, but it has a slower onset of action. And then the third is a tetracaine. This kind of works synergistically with the other two to help provide a longer and deeper numbing effect.
Considerations for Using BLT Cream
So you can apply the cream, and that will help. And the question becomes, why do we use it every time? There are a couple of factors to consider. One is it’s quite expensive. So insurance doesn’t cover this, so you will have to pay out of pocket for the cream. Please note that if you’re trying to cover your entire leg, you’ll need a lot of cream, and it’ll be quite pricey. So we certainly don’t recommend that.
Number two is if you use too much, these agents actually can be toxic. So there’s a limited amount you can use in one sitting; therefore, you need to be a little sparing with it. And number three is it takes time to work. So, the minimum time required is about 10 minutes. Ideally, get the maximum effect after 45 minutes. However, it’s not practical to spend time at the office to spend 45 minutes and then get another half-hour injections.
So these things are not really possible. You can’t put the anesthetic on before you come because otherwise, it’ll wipe off your clothes. Or, if you wrap it in plastic wrap or Saran wrap, it’ll cause quite a bad irritation of the skin. Your skin will become red and inflamed, and actually, there’s no way than to do the injection. So that’s certainly not a strategy.
Practical Use of Topical Cream at Our Office
So, what you can do and what I recommend is that you go into the room, let’s say, 10 to 15 minutes before the injections, and try to get as much time as possible. And then, you take a small amount of the numbing cream. You should put a glove on first because you don’t want to numb the fingers. And then, I would apply it in the areas that are most sensitive, so around the ankle, around the knee.
Next would be the calf. And if you see a large area of veins on your thighs, you could certainly put it there. That is usually the least painful because it’s not so close to the bone. There’s more flesh there. However, if you have an X-ray, you can certainly use it. And then, after 10 or 15 minutes, we will try and start the process. We can also start injecting higher up and moving down so that the most sensitive areas have a little more time to numb up. So this is certainly a strategy that could be used.
We certainly offer it; however, oftentimes, it is not needed. And if you just use your breathing techniques and if you take an analgesic before you come, often that’s enough. And it depends on the patient. Some patients are much more anxiety-prone; they are afraid of needles, and they have trouble when they get their blood drawn or anything like that.
And so, using the BLT cream is a good idea. And sometimes, it’s just sort of a placebo effect. You know, something’s being done. It does not completely affect the area, but it lessens the sting of the needle, and that may be enough to get you through the procedure.
Ready to Treat Your Spider Veins?
If you are interested in sclerotherapy for your spider veins, please don’t hesitate to contact us at the Metropolitan Vein Aesthetic Center. We’d love to offer you a complimentary consultation to discuss treatment options, and we can also explore these strategies to help you navigate the procedure. Hopefully, we’ll give you a beautiful cosmetic result, and you’ll be happy and able to show off your legs. Again, thank you for your time.
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