Use of a Mobile Phone as a Vibrating Device to Ameliorate Pain During Injections

Clinical Challenge

Vibration to ameliorate pain, based on gate theory, has proven efficacy.[1,2] Good proprietary vibratory devices can cost between Rupees 5 and 10,000 on an average. Procuring these in remote areas is difficult. In our experience, many of these devices have questionable quality and servicing. We explored if a mobile phone could serve as an effective vibrating device in procedural dermatology.

Solution

Consecutive patients (recruited by convenience sampling), who were being subjected to injection as a part of a dermatological procedure, were explained about the procedure. Written informed consent was taken before the procedure. Pain was quantified initially without, and later with the use of the vibrating phone. Pain quantification was done by a 10-point visual analogue scale (0 and 10 denoted absent and maximum pain, respectively). A vibrating application (Vibrator: Strong vibration app®) was downloaded and set to maximum intensity (which exceeded the maximum innate vibration intensity of the mobile phone). The phone was wrapped in a sterile glove and firmly applied (for maximal intensity) to the adjacent skin a few seconds before injection [Video 1]. A statistically significant pain reduction was noted overall and, in all groups individually, using paired t-test (P < 0.05) [Table 1]. No side effects of the use of the vibrating device were noted.

Table 1.

Extent of reduction in pain in different procedures

Procedure	Number of patients	Breakup of sites	Mean (±SD) pain score before the use of the vibrating mobile phone	Mean (±SD) pain score with the use of the vibrating mobile phone	P (paired t-test)
Platelet-rich plasma therapy	50	Scalp (n=50, 100%)	5.89 (±1.97)	2.12 (±1.67)	P<0.05
Intralesional triamcinolone acetonide injection	11	Chest (n=5, 45.45%), scalp (n=4, 36.36%), beard and leg (n=1, 9.09%, for each)	5.4 (±2.45)	2.09 (±1.81)	P<0.005
Lidocaine injection*	13	Scalp (n=4, 30.77%), forearm (n=3, 23.08%), foot (n=2, 15.38%), finger, lip, neck, thigh (n=1, 7.69% for each)	5.23 (±2.69)	2.37 (±1.42)	P<0.005
Miscellaneous^	5	NA	NA	NA	NA
Overall	79		5.65 (±2.24)	2.18 (±1.62)	P<0.005

P<0.05 is significant. *To avoid confounding, lidocaine injections before and with the vibrating mobile were performed at different sites. ^One patient each of needling for vitiligo on the foot, hydrodissection with normal saline for a scar on the forehead, carbon dioxide laser for a keloid on the chest, radiofrequency ablation for scalp verruca and for needling for molluscum contagiosum on the face. Pain scores before and with vibrating mobile application were (8 and 2), (7 and 3), (9 and 4), (3 and 3), (2 and 0) in these patients, respectively. Owing to the heterogenous sample, statistical analysis was not done in this group

Vibrations of the mobile phone are above 100 Hz (the minimum for analgesia).[3] Many vibratory applications are freely downloadable and legal, including Vibrator Strong Vibrator app®, Vibrava: Vibrator app®, Strong Vibes-Vibrator app®, etc. In children, soothing music may be played concurrently on the phone. This technique can be used impromptu if the proprietary vibrating device is out of order or inaccessible, e.g., in rural areas.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)

The preparation of this manuscript was carried out entirely by the author without the use of artificial intelligence technologies.

Funding Statement

Nil.