• Pain on injection can be immediate or delayed (10-20s later)
  • Cause remains unclear
  • Possible mechanisms include:
    • Direct irritant effect of phenol (particularly that in aqueous phase)
    • Effect of pH or osmolarity – considered less likely as solution almost isotonic with physiological pH
    • Indirect effect due to release of local inflammatory mediators such as kininogenin

 

Detailed discussion is given in an article by tan et al.