Texting may help relieve pain during minor surgery

"Need pain relief for surgery? Try a text," the Daily Mail reports. The advice was prompted by a small study that found people who used a mobile phone during minor surgery were less likely to require additional pain medication.

During surgery, participants in this study were allocated to texting a close friend or family member, texting a research assistant they did not know, playing Angry Birds, or receiving usual care.

Researchers found patients who used a mobile phone to text someone were less likely to need additional painkillers during surgery. Interestingly, people who texted a research assistant tended to need slightly less painkillers than those who texted somebody that they knew.

The researchers speculate this could be because the conversations with the research assistant were not about their surgery, so this may have helped take their mind off the experience.

While the study was well designed, it was relatively small and may not be representative of all people having this type of surgery, or be able to detect small effects.

Larger studies assessing a wider variety of pain-related outcomes, such as the patient's own rating of their pain, are needed to confirm the findings.

Distraction techniques and social support can be useful self-help methods for coping with pain. 

Where did the story come from?

The study was carried out by researchers from Cornell University in the US and McGill University and LaSalle Hospital in Canada, and was funded by Cornell University. It was published in the peer-reviewed journal, Pain Medicine.

The Daily Mail covered the story reasonably, but does not highlight any of the study's limitations. The Daily Telegraph's headline, "Angry Birds could reduce pain during surgery, study finds", is misleading. There was no statistically significant difference between the "Angry Birds" group and the "no special activities" group in terms of their need for the painkiller.

It would be a shame if the paper just included the term to create an eye-catching headline rather than trying to report the study accurately.  

What kind of research was this?

This was a randomised controlled trial (RCT) looking at whether text messaging or playing a mobile phone game during minor surgical procedures could reduce patients' need for a strong painkiller.

Having social support has been reported to have a number of benefits, including reducing a person's pain sensation and making them able to bear pain for longer (in childbirth, for instance).

Distraction techniques, such as listening to music or using virtual reality simulations, have also been reported to help reduce anxiety and people's need for anaesthesia.

The researchers were interested in whether social support (in the form of text messaging) would have a greater effect than just being distracted (in the form of a game).

They also tested whether there was a difference between texting a friend or family member, who might be anxious about the person's surgery, and texting a stranger. An RCT is the best way to compare the effects of different interventions.  

What did the research involve?

The researchers recruited 98 adults scheduled to undergo minor surgery with regional, rather than general, anaesthesia. They allocated them at random to perform one of four things just before and during their surgery:

• texting a close friend or family member
• texting a research assistant they did not know about their hobbies and interests, for example
• playing Angry Birds on a phone
• no special activities (usual care)

The participants had the normal pre-surgery procedures, including being given their anaesthesia and initial dose of painkillers.

All except one of the anaesthetists (the doctors who give anaesthetic during surgery) did not know the aim of the study or what it was measuring. They knew whether the patient had a phone with them, but were not told what the patient had been asked to do with it.

The anaesthetists asked patients if they were in pain after the first surgical incision was made, then again within the first 5-10 minutes of surgery and throughout the procedure. If the patient reported pain, the anaesthetist could give them the painkiller fentanyl or sedation as they judged appropriate.

The researchers then compared the groups to see if they differed in terms of how much fentanyl was needed during the surgery.

What were the basic results?

The patients in the four groups did not differ in their anxiety levels before surgery, or the type of surgery or how long they were in the operating room. Only about a quarter of the patients (27.6%) needed extra fentanyl during the surgery.

The researchers found that:

• patients who texted a close friend or family member during their surgery needed less fentanyl than those who did not do any of the activities
• patients who texted the research assistant needed less fentanyl than those playing the game and those who did not do any of the activities
• patients in the two texting groups did not differ significantly in their need for fentanyl
• patients in the game group and those who did not do any of the activities did not differ significantly in the amount of fentanyl they needed

The researchers also analysed the odds of needing additional fentanyl during surgery. They report that those doing nothing were four times more likely to need more fentanyl than those texting friends or family, and six times more likely than those texting the research assistant.

Looking at the text conversations, those who texted the research assistants tended to be more positive, while the texts with a friend or family member tended to use more biological terms, so seemed to focus on the surgery itself. 

How did the researchers interpret the results?

The researchers concluded that their study "provides the first evidence of the analgesic-sparing benefits of social support from text messaging in a surgical setting". 

Conclusion

This relatively small study suggests text message conversations during minor surgery may reduce the need for painkillers, and are more effective than playing the game Angry Birds.

The study was an RCT, the best design for comparing different interventions, which should ensure the groups were well balanced. This means any differences in the patients' outcomes should be the result of the interventions.

But this study does have some limitations:

• It was relatively small and may not be representative of all people having this type of surgery. The authors suggest the study's small size may also be why they did not find an effect for the Angry Birds intervention.
• The anaesthetists could not be completely blinded to which group patients were in, as they knew whether the person had a phone with them. They may also have been able to guess what a person was doing (texting or playing a game) based on their hand movements or expression. This might influence their perception of the participants' pain.
• Being engaged with the phone might affect the frequency anaesthetists asked the participants about their pain. The researchers say they tried to make sure this wasn't the case, but acknowledge this was down to the discretion of the anaesthetists.
• It only assessed one outcome. Ideally, comparison of the patients' own assessment of pain and satisfaction with the procedure would be an important outcome to assess.

There is interest in developing non-drug-related methods to reduce people's pain and discomfort during surgery or other procedures.

The researchers suggest that texting could be a good approach, as it is simple and doesn't need specialised equipment or input from healthcare staff. However, whether this would be considered acceptable from an infection control perspective is unclear.

Overall, this study suggests that using a mobile phone during surgery has some effect, but larger studies assessing a wider variety of outcomes are needed.