Saturday, December 19, 2009

Want Less Pain? Rip Off Adhesive Bandage Quickly

Australian researchers, in somewhat of a holiday jesting spirit, have answered one of pain medicine’s oldest questions: Is quickly ripping off an adhesive bandage strip (aka, Band-Aid®) less painful than the slow tug method? Faster appears to be better, but there are limitations.

During a controlled research trial — conducted at James Cook University and published in the pre-holiday edition of the Medical Journal of Australia — medium-sized plastic adhesive bandage strips were applied to 65 hapless medical students who "volunteered" for the experiment. None had an actual injury covered by the strip and each was asked to rate the pain from 0-to-10 when the strip was removed (0 being “no pain,” 10 signaling “worst pain imaginable”).

According to study coauthor Carl O'Kane the average pain score for slow removal was 1.58 and for fast removal it was only 0.92 (a significant 45% decrease). As with other research in pain medicine, women seemed to have higher pain tolerance; the average pain scores for women were significantly lower than for men. Although, as O’Kane conceded, men tended to have more body hair and a high body-hair score was associated with higher pain scores, as one might expect.

For the record: A number of limitations should be noted. All subjects were healthy young adults, without allergies to adhesive dressings, chronic pain, or serious anxiety disorders. O’Kane acknowledges that “These results would not be applicable to patients with wounds, particularly chronic wounds and ulcers, that may adhere to bandaids or other simple dressings.” Presumably, anxious patients also might not react the same as study group participants, nor might children or older persons. Clinician skill in applying the removal technique might make a difference. O’Kane conceded that students who were tested by one of the two operators reported higher pain levels than those tested by the other operator; so, “This may indicate that there are skilled bandaid removers and less-skilled or unskilled bandaid removers.”

Another way of looking at the data is that slow adhesive bandage removal increases pain by 72%, which sounds menacing; at least until one considers that a brief burst of pain even at the higher 1.58 average level (on an 11-point scale) due to unhurried, careful removal is not much to worry about, especially if there is a scab (eschar) or other wound underneath at risk of being disturbed. And, yes, the study was adequately powered to confirm the differences as being statistically significant; albeit, this is a case where the findings are probably not of true clinical significance.

Reference: O’Kane C, et al. Fast bandaid removal less painful than slow bandaid removal. MJA [News Release]. 2009(Dec 13);191[11/12]).

Happy holidays, 2009, from the Pain Treatment Topics team!