Emergency Physicians often practice intramuscular injections of sterile water for injection (SWFI) as a placebo effect to questionable psychosomatic or factitious pain disorders, however it is not advisable.

Hypotonic solutions such as Sterile water or 5% Dextrose cause substantial swelling of the subcutaneous tissue & block the microcirculation.

There is an ongoing practice of intradermal injections of Sterile water over the sacrum for Labour analgesia by causing pain and then desensitizing the nerve endings.

But, other than that, SWFI doesn’t outweigh the adverse effects it has as compared to questionable benefits in factitious pain or somatoform disorders.

The management for such illnesses should be individualized (according to standard treatment guidelines).

Hypertonic solutions too cause pain and swelling but cellular shrinkage, which is one of the reasons to be careful with administering 50% Dextrose for hypoglycemia or along with Insulin in management of severe/symptomatic hyperkalemia. Its extravasation can lead to extreme pain, either due to neurovascular irritation or again microvascular obstruction.



  • Tissue damage at the injection site after intramuscular injection of drugs – F. Ramussen


  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900101/

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