Taking the sting and stress out of dermatologic procedures requires low-tech distraction techniques and, often in the case of children, amusing apps.
Therapeutic adjustments and distractions including entertaining apps can ease discomfort for pediatric and adult patients, making everyone's day easier, said an expert at the 75th American Academy of Dermatology Annual Meeting.
Dr. McQueen"Some of the strategies we've used to help make procedures easier to tolerate for children and their parents are also useful for adults. Just because adults can tolerate pain doesn't mean that we shouldn't try to make it easier to tolerate," said Alisa McQueen, M.D. She is associate professor of pediatrics at the University of Chicago Comer Children's Hospital.
Minimizing patients' pain or discomfort also makes procedures more efficient and effective, she says. With topical anesthetics, she suggests making small adjustments like buffering lidocaine with sodium bicarbonate, using the smallest gauge needle possible and warming the anesthetic to body temperature.
"We are also trying to use what we know about the gate theory of pain to advocate for occupying the nerve fibers that are closest to the procedure, by using vibration or temperature." Placing a small vibrating device such as the Buzzy (MMJ Labs) between the treatment area and the brain has been shown to reduce the experience of pain, she says.
"Our experience of a painful or noxious event is magnified when we pay attention to it. You can use devices that you probably have already - smartphones and tablets can help to reduce the experience of pain. And there's an art to it - don't just hand the patient an iPad and go for it. You must prepare them in a way that sets you up for success."
For starters, she recommends positioning the patient so that they can focus on the distraction, and ideally not even see the procedure. "Picking the right apps or videos depends on a child's developmental capability, as well as what you need to accomplish."
A painful experience calls for different preparation than one that's simply scary, she says. "Freezing a wart or lesion isn't painful the way a needle injection is. But the procedure might make kids nervous." To calm them, she suggests playfully aiming the device at a flower petal or other object so they can see its effects before beginning the procedure.
"For a long time, Angry Birds was a major go-to because it's easy to learn and very familiar to people. That works better for older children." Younger kids tend to like cooking-oriented apps, such as Candy Doodle, that let them physically manipulate the device. Young children also seem to enjoy highly interactive newer apps by Toca, she says. With these apps, "The user must focus a bit and create a story and a world. You can accomplish a lot because they're quite unaware of what you're actually doing."
It's also important that apps use sound, Dr. McQueen says.
"Sound occupies another part of the brain. Also, patients are less likely to hear other sounds," such as the opening of a package or the clip of a hemostat.
Although these strategies come from pediatrics, she says, "They're very useful and effective for adults as well. In a world where adults frequently have anxiety around procedures and needles, it can occupy a lot of our time trying to manage the anxiety."
Disclosures: Dr. McQueen reports no relevant financial interests.