Vibration for Pain Reduction in a Plastic Surgery Clinic

Eichhorn, Mitchell G.; Karadsheh, Murad J.; Krebiehl, Johanna R; Ford, Dawn Marie; Ford, Ronald D.

doi:10.1097/psn.0000000000000134

Cited by 8 publications

(6 citation statements)

References 21 publications

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“…8 The application of a vibratory stimulus has been shown to improve patient discomfort associated with cosmetic botulinum toxin injections. 6,9 The ''gate-control'' theory, initially proposed in 1965, suggests that intensity of pain can be mitigated by concurrent non-noxious stimulation. 10,11 Studies have applied this theory to eyelid local anesthesia injections, 12 dermal filler injections, 13 and keloid steroid injections 14 with reduction in pain outcomes.…”

Section: Introductionmentioning

confidence: 99%

Vibration Versus Ice to Reduce Cosmetic Botulinum Toxin Injection Pain—A Randomized Controlled Trial

Chorney

Villwock

Suryadevara

2019

Ear, Nose & Throat Journal

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Botulinum toxin is the most commonly performed facial cosmetic procedure and pain at the injection site is a frequent patient concern. While various topical interventions have been described for analgesia, there have not been any studies comparing different techniques. We compared the use of a vibratory stimulus, ice pack application, and no intervention on injection site pain for cosmetic botulinum toxin injection. A prospective-, randomized-, individual-controlled study was conducted using a visual analog scale to assess pain. Patients received bilateral glabellar injections, with randomization into unilateral vibration, unilateral ice application, or vibration and ice on either side. We analyzed 88 injections on 22 patients. Mean visual analog scores were 26.5 (standard deviation [SD]: 23.1) among injections with vibration, 24.4 (SD: 22.9) with ice, and 29.4 (SD: 27.1) without analgesia. There was no significant difference in pain scale scores with the use of vibration, ice, or no topical anesthesia ( P = .737). Further, pain scale scores did not differ significantly between medial and lateral injections nor did patients have a reduction in pain on either side of the forehead regardless of which method was used. While there may be a role for topical interventions to improve injection site analgesia, we maintain that consistently proper technique plays a greater role in improving patient tolerance. Future studies will continue to investigate the role of topical anesthesia in cosmetic facial injections and address patient-specific factors contributing to discomfort.

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Section: Introductionmentioning

confidence: 99%

Vibration Versus Ice to Reduce Cosmetic Botulinum Toxin Injection Pain—A Randomized Controlled Trial

Chorney

Villwock

Suryadevara

2019

Ear, Nose & Throat Journal

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“…Vibration has been previously shown to significantly decrease pain perceived by patients in multiple clinical settings, but, to our knowledge, had not been tested in those who catastrophize pain. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] In our study, we found that patients who catastrophized pain experience a minimum clinically difference in relative change (≥22%) and patients who did not catastrophize pain experience a substantial clinically important difference (≥57%) with the use of vibration during anesthetic injection (Table 3). 39 During multivariate analysis of the entire cohort, the only variable to significantly affect the perceived pain of patients during anesthetic injection was the presence of the VAD (F statistic, 2.741; P = .03) (eTable in Supplement 2).…”

Section: Discussionmentioning

confidence: 86%

“…The use of nonnoxious tactile stimulation, specifically vibration, has been shown to significantly decrease pain perceived by patients in many clinical settings . Generalizability of these previous studies are limited owing to small sample size, the use of volunteers, and unreported and/or unperformed participant training for accurate pain score reporting.…”

Section: Introductionmentioning

confidence: 99%

“…8,13,21,22 The use of nonnoxious tactile stimulation, specifically vibration, has been shown to significantly decrease pain perceived by patients in many clinical settings. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Generalizability of these previous studies are limited owing to small sample size, the use of volunteers, and unreported and/or unperformed participant training for accurate pain score reporting. This study aims to promote generalizability by including a typical dermatologic surgery patient population, without exclusion of previous condition(s), who are undergoing scheduled skin cancer removal surgical procedures.…”

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confidence: 99%

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Effect of a Vibratory Anesthetic Device on Pain Anticipation and Subsequent Pain Perception Among Patients Undergoing Cutaneous Cancer Removal Surgery

Govas

Kazi

Slaugenhaupt

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCE Vibration has been shown to decrease injection site pain in patients; however, to date, this effect has not been assessed for patients who catastrophize pain (ie, patients who anticipate a higher pain level). The anticipation of a pain score greater than 4 on the 11-point Numeric Rating Scale (NRS) has been associated with an increase in a patient's perception of procedural pain.OBJECTIVE To assess the efficacy of vibration during cutaneous anesthetic injection for dermatologic surgery for patients who catastrophize pain (NRS score >4) and patients who do not (NRS score Յ4).DESIGN, SETTING, AND PARTICIPANTS Randomized, parallel-group clinical trial from June 19 to September 4, 2018, at a tertiary dermatologic surgery clinic among 87 adults undergoing cutaneous cancer removal surgery. Patients completed a preprocedural questionnaire detailing their baseline pain, anticipated pain, and drug use. Analysis was performed on an intent-to-treat basis.INTERVENTIONS Use of a vibratory anesthetic device (VAD) on the treatment site prior to anesthetic injection in the on (VAD ON) or off (VAD OFF) mode.MAIN OUTCOMES AND MEASURES Pain was reported using the 11-point NRS (where 0 indicates no pain and 11 indicates the worst pain imaginable). A minimum clinically important difference of 22% or more and a substantial clinically important difference of 57% or more were used to assess the efficacy of vibration in patient-reported NRS score during anesthetic injection (iNRS score).RESULTS A total of 87 patients were included, with 101 unique events reported (among the unique events, 37 were reported in women and 64 were reported in men; mean [SD] age, 66.0 [11.3] years). The mean (confidence level [CL]) iNRS score for patients who catastrophized pain was 2.27 (0.66) compared with 1.44 (0.39) for patients who did not (P = .03). A 38.9% decrease in mean (CL) iNRS score was reported with VAD ON compared with VAD OFF in all participants (1.24 [0.38] vs 2.04 [0.54]). Patients who catastrophized pain reported a 25.5% decrease in mean (CL) iNRS score with VAD ON vs VAD OFF (1.91 [0.99] vs 2.57 [0.98]), and patients who did not reported a 79.4% decrease (1.02 [0.40] vs 1.84 [0.66]). VAD ON was the only statistically significant variable to affect iNRS score (F statistic, 2.741; P = .03).CONCLUSIONS AND RELEVANCE This trial demonstrates that those who catastrophize pain prior to a procedure report a higher perceived level of pain. 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. LEVEL OF EVIDENCE 2.TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03467685

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“…42,43 Furthermore, many small cohort studies found that age was not a factor in patient response to vibration analgesia. 17,24,44 In the intraoperative MMS setting, younger patients are more likely to report pain. 3 However, postoperatively, there are conflicting findings; Limthongkul and colleagues showed no correlation between age and pain, whereas Firoz and colleagues reported increased pain in younger patients.…”

Section: Discussionmentioning

confidence: 99%

Differential Analgesia From Vibratory Stimulation During Local Injection of Anesthetic: A Randomized Clinical Trial

et al. 2019

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BACKGROUND-Inadequate pain reduction during anesthetic injection is a significant medical and surgical problem. Vibratory distraction reduces this pain; however, there are minimal data identifying those who respond best. OBJECTIVE-To quantify analgesia from vibration before anesthetic injection.MATERIALS AND METHODS-In this partially blinded, single-institution trial, adult participants were randomized to intervention (vibratory anesthetic device, VAD ON) or placebo (VAD OFF). Pain was assessed using the 11-point numeric rating scale (NRS). Relative reduction in NRS between VAD OFF and ON was used to identify minimum clinically important and substantially clinically important difference in pain.RESULTS-One hundred one tested sites from 87 subjects were assessed. Sixty-three percent were men with a median age of 66 years. From univariate analysis, males, subjects aged <60, and head and neck (HN) treated subjects had a significant reduction in NRS (p < .05). Multivariate analysis identified NRS reductions in females <60 (p = .012), males ≥70 (p = .002), females and males treated on HN (p = .048 and p = .035, respectively), and males ≥70 treated on HN (p = .012). Substantially clinically important difference (≥57% NRS reduction) included subjects <60, females <70, HN treatment aged 60 to 69, males ≥70, and females treated on HN.CONCLUSION-Vibratory anesthetic device reduces pain during anesthetic injection, primarily for HN treatments and older male subjects.

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Vibration for Pain Reduction in a Plastic Surgery Clinic

Cited by 8 publications

References 21 publications

Vibration Versus Ice to Reduce Cosmetic Botulinum Toxin Injection Pain—A Randomized Controlled Trial

Vibration Versus Ice to Reduce Cosmetic Botulinum Toxin Injection Pain—A Randomized Controlled Trial

Effect of a Vibratory Anesthetic Device on Pain Anticipation and Subsequent Pain Perception Among Patients Undergoing Cutaneous Cancer Removal Surgery

Differential Analgesia From Vibratory Stimulation During Local Injection of Anesthetic: A Randomized Clinical Trial

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