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Vibrating Device Lowers Pain From Cutaneous Cancer Removal

A vibratory anesthetic device relieved injection-site pain during cutaneous cancer removal procedures involving local anesthesia, both in patients who tended to catastrophize pain and in those who did not, a randomized clinical trial found.

Device use led to a 79.4% decline in Numeric Rating Scale (NRS) scores during local anesthetic injection in patients who do not catastrophize pain and a 25.5% decline in patients who do, reported Panayiota Govas, MD, MScMed, of the University of Pittsburgh, and colleagues.

The findings, published online in JAMA Facial Plastic Surgery, confirm that those who catastrophize pain before a procedure report a higher perceived level of pain, noted the investigators. “The application of vibration during local anesthetic injection resulted in a minimum clinically important difference in pain level for patients who catastrophize pain and a substantial clinically important difference in pain level for patients who do not,” the authors wrote.

In the clinical setting, patients who catastrophize pain can be identified by evaluating their anticipation of pain levels as indicated by an NRS score over 4, and these individuals benefit from the use of vibration during local anesthetic injection, the team continued.

Prior studies suggest that there are adjuvant approaches that providers can take to help decrease the pain that patients experience during procedures, especially when it comes to outpatient procedures, noted Hayley Goldbach, MD, of the University of California Irvine, who was not involved in the trial.

This study gives “us more information about what types of patients are coming into the office, and whether or not we need to alter our strategy,” Goldbach told MedPage Today. “In this case, it’s suggesting that the vibrating device is helpful in both groups, but it may be more helpful in groups who aren’t anticipating pain as much.”

There is some degree of distraction at play, noted Neil Tanna, MD, MBA, of Northwell Health in Great Neck, New York. “I think there are also audiovisual ways to distract someone, and possibly decrease pain or at least the anticipation,” he told MedPage Today. “I know that we sometimes use virtual reality for patients who are going to get a procedure when we want to distract them, and I know there have been studies looking at music or looking at virtual reality to distract patients.”

Goldbach said there are “definitely other techniques that are commonly used that include talking to patients, topical numbing agents, and even music, but a reusable vibrating device is something that a lot of practitioners are interested in because it is sort of economical, environmentally friendly, and really has been shown to significantly decrease patients’ pain.”

Study Details

For the study, Govas and colleagues randomized 49 patients to treatment with the vibratory anesthetic device on (VAD ON) and 52 to the group with it off (VAD OFF). Participants (mean age of 66) had 101 unique events.

Patients participated in a training session to address trial questions based on the 11-point NRS, which ranges from 0, indicating no pain, up to 11, indicating the worst pain imaginable, and to offer descriptive adjectives regarding sensation.

The VAD — a handheld, battery-powered device measuring about 10 cm in length — was positioned on the training site about 5 cm away from the patients’ treatment sites in the off mode for 15 seconds. Participants were then asked to use the NRS score to describe the pain level they experienced and to describe the sensation they felt on their skin. This procedure was then repeated, but this time, the VAD was in the on mode.

All participants were 18 years or older and presenting for surgical excision, Mohs micrographic surgery, and/or other cutaneous cancer removal surgery at a single center. Patients completed a preprocedural survey on their baseline pain, drug use, and expected pain. Analysis was done on an intent-to-treat basis.

Participants were excluded due to nonattendance, language barrier, inability to follow directions, participation refusal during appointment, and a procedure canceled secondary to a concomitant medical problem.

The average NRS score during anesthetic injection (iNRS) for patients who did not catastrophize pain was 1.44 vs 2.27 for those who did (P=0.03).

The only statistically significant variable to affect the iNRS score was VAD ON (P=0.03).

Compared with VAD OFF, there was a 38.9% decline in average iNRS score reported for VAD ON across all participants (2.04 vs 1.24).

Limitations of the trial, the researchers said, included that it is impossible to fully blind both clinician and patient from the assigned intervention due to the nature of vibrations and possible selection bias due to this being an elective study in which patients who were more likely to catastrophize pain self-selected to not participate. Another limitation, the team added, is the generalizability of the study because it relied on a single operator at a single center.

The study was funded by the National Institutes of Health.

Govas reported no disclosures.