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Pain alleviation during cryotherapy of plantar viral warts using a non-invasive vibratory device: a randomised intra-individually controlled trial
  1. Yun Pei Koh1,
  2. Melissa M Chan1,
  3. Xiahong Zhao1,
  4. Lucinda Tan1,
  5. Hong Liang Tey1,2
  1. 1 Dermatology, National Skin Centre, Singapore
  2. 2 Department of Medicine, NUS Yong Loo Lin School of Medicine, Singapore
  1. Correspondence to Dr Yun Pei Koh, Dermatology, National Skin Centre, 308205, Singapore; ypkoh{at}

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What are the new findings?

  • We designed a vibration device that can provide vibrational stimulus surrounding a treatment area, to provide pain alleviation while enabling cryotherapy to be properly performed. This is in contrast to current devices in the market, which provide vibratory stimulus only adjacent to the site of pain or have limited surround vibratory effects.

  • Our device has been shown to significantly reduce pain scores in both adult and paediatric patients undergoing cryotherapy for plantar warts.

How might it impact on healthcare in the future?

  • A lowered pain score through the usage of the device may translate to better compliance to the frequency and duration of cryotherapy.

  • The device may also be modified for various types of procedures, such as botulinum toxin and filler injections, laser procedures and intralesional steroid injections.


Viral warts are common cutaneous infections, with 2% of the general population seeking medical care annually.1–3 In a study involving school children, the annual incidence rate of plantar warts was 14%.4 Cryotherapy is often first-line therapy in dermatological clinics. We have previously found that patients exhibit significant pre-procedural anxiety due to cryotherapy-related pain and discomfort.5

There are vibratory devices proven to relieve injection-associated discomfort and pain in dermatological and facial procedures, such as botulinum toxin or filler injections.6 7 Devices used range from commercially available inexpensive body massagers to specific vibrating devices designed for medical or dental use.8 Most are not intended for use in clinical procedures and unable to achieve maximum benefit in terms of pain relief.9 Currently, a commercially available device, Buzzy (MMJ Labs, Atlanta, Georgia, USA), was shown to significantly lower venepuncture associated pain in paediatric populations.10 11 Buzzy also lowered lower extremity injection associated pain when strapped on proximally to the injection site. However, the device was applied away from the site of procedure and there were reported difficulties applying …

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  • Contributors HLT and LT planned the study. YPK wrote the manuscript and collected patient data. MMC and XZ assisted with data collection and statistical analysis.

  • Funding HLT is supported by the National Medical Research Council of Singapore grant NMRC/CSA-INV/0023/2017.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.