The army of steel ants: how pain was managed between treatments, then and now
What the chapter “Prescription Pain” reveals — and what changed in pediatric pain management
There’s a kind of pain you choose, and another that simply happens to you. In The First Kiss: Hell in the Skin, Uyanic draws a line between the two with a clarity only lived experience can give:
“The accident’s pain was a tsunami: chaotic, total, annihilating. The doctor’s pain is an army of steel ants: disciplined, localized, with a purpose.”
That second, “chosen” pain was from the triamcinolone injections used to treat her keloids. And it came with no anesthetic applied beforehand at all.
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The protocol back then: only ice, and only afterward
The book describes the procedure with clinical precision: long, thin needles infiltrating corticosteroid directly into fibrous scar tissue, session after session, with no topical or local anesthetic applied before the needle. The only relief came afterward, and it was simple:
“Apply ice, twenty minutes every hour. Don’t touch it. Next session, in three months.”
No numbing cream, no planned distraction, no premedication. Pain management at that time and place depended almost entirely on the patient’s own endurance — a child’s — and her mother’s hand holding the one that wasn’t bandaged.
📖 A real testimony, not a medical guide
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What changed: managing children’s pain in needle procedures
Today there’s clear clinical consensus, specifically for elective needle procedures in children, that pain isn’t an inevitable side effect to be treated only afterward — it’s prevented beforehand, with several combined strategies.
1. Topical anesthesia before the needle
Creams combining lidocaine and prilocaine (known as EMLA) are applied to the skin 30 to 60 minutes before the procedure, numbing the area before the needle even touches it — something that simply doesn’t happen in the book’s chapter.
2. Mixing the anesthetic with the corticosteroid itself
In intralesional injections like the one described in the book, it’s now recognized practice to mix the corticosteroid with local anesthetic, or to apply local anesthesia to the tissue before infiltrating — reducing the pain of the infiltration itself, not just the initial needle prick.
3. Managing behavior, not just the drug
Current evidence on pediatric pain points to something the book illustrates without knowing it: pain control in children depends as much on managing anxiety and positioning as on the procedure itself. Today’s guidance is to offer several strategies at once — comfortable positioning, a distraction technique, topical anesthesia — rather than a single, isolated measure.
4. Ice is still valid — it’s just no longer the only tool
The post-procedure ice that Dr. León prescribed is still a reasonable recommendation today. The difference is that now it’s a complement within a broader protocol, not the only tool available.
Between the testimony and the protocol
Dr. León did nothing outside the standard of his time and context — and the book doesn’t present him as negligent, but as precise within the tools he had. What changed isn’t the doctor’s good intent; it’s how much preventable pain is considered acceptable to let happen today.
Frequently asked questions about pain in needle procedures
Why wasn’t topical anesthesia used for this kind of injection back then?
Not because the concept didn’t exist, but because its systematic use in outpatient dermatological procedures like this one wasn’t standardized practice the way it is today.
Does topical anesthesia work equally well at any age?
Creams like lidocaine-prilocaine can be used across any age range, including the neonatal period, according to current medical literature — which makes it especially relevant for a case like Uyanic’s, treated since childhood.
What is “The First Kiss” about?
It’s the real-life testimony of Uyanic, who survived a fire at age 10 and describes in the book, among other things, the long and painful process of treating her scars with Dr. León.
Want the rest of the story? Discover how Uyanic lived through it in The First Kiss: Hell in the Skin.
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