Vibration May Dull Pain From Anesthetic Injection

By Reuters Staff

September 20, 2019

NEW YORK (Reuters Health) - A vibratory stimulus reduces pain from anesthetic injections given before skin cancer surgery, and is most effective for patients who don't catastrophize pain, according to new findings.

"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," Dr. Panayiota Govas of the University of Pittsburgh, Pennsylvania, and colleagues write in JAMA Facial and Plastic Surgery, online September 12.

Pain catastrophizing occurs when a person anticipates more pain, and has been linked to higher levels of perceived pain, anxiety, depression and disability, the authors note. Studies show that vibration can reduce perceived pain, they add, but this approach has not been tested in patients who catastrophize pain.

Their study included 87 patients who underwent a total of 101 cutaneous cancer surgeries at a tertiary dermatologic surgery clinic. Twenty-six patients catastrophized pain, meaning they rated their anticipated pain above 4 on a numeric pain scale of 0 to 10, with 10 being the worst possible pain, while 75 did not.

Patients were randomized to receive treatment with the vibratory anesthetic device in on- or off-mode. The most frequent testing site was the head and neck region, followed by the extremities and the trunk.

Overall, mean injection pain scores decreased 38.9% with VAD on compared to VAD off. The mean decrease was 79.4% for the non-catastrophizing group and 25.5% for the catastrophizing group.

Specifically, for non-catastrophizing patients, mean anticipated and actual pain scores were 1.79 and 1.84, respectively, with the VAD off and 1.67 and 1.02 with the VAD on.

For catastrophizing patients, anticipated and actual pain scores were 6.0 and 2.57 with the VAD off and 5.75 and 1.91 with it on.

Regression analysis showed a significant effect on pain of the vibration.

"Clinically, we will continue to use vibration on our patients; however, we recognize that those who catastrophize may require further intervention for pain relief in addition to vibration alone," Dr. Govas and colleagues write. "Our findings suggest that future studies should consider assessing the efficacy of other nonnoxious tactile stimulation devices, sensations, or techniques."

The study had no commercial funding, and the researchers report no conflicts of interest.

Dr. Govas was not available for an interview by press time.

SOURCE: https://bit.ly/2mmqIrx

JAMA Facial Plast Surg 2019.

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