Objective: To determine whether slow or fast bandaid removal is less painful. \ud
\ud
Design, setting and participants: A prospective, randomised, crossover trial was carried out at James Cook University, Townsville. Participants were healthy volunteers\ud
from Years 2 and 3 of the James Cook University medical school program.\ud
\ud
Interventions: Medium-sized bandaids were applied bilaterally in three standard body locations and removed using slow and fast techniques.\ud
\ud
Main outcome measures: Pain scores were assessed using an 11-point verbal numeric pain scale.\ud
\ud
Results: 65 participants were included in the study. The overall mean pain score for fast bandaid removal was 0.92 and for slow bandaid removal was 1.58. This represents a\ud
highly significant difference of 0.66 (P < 0.001).\ud
\ud
Conclusion: In young healthy volunteers, fast bandaid removal caused less pain than slow bandaid removal

Aitken, Peter J.

Banks, Colin J.

Furyk, Jeremy S.

Kault, David A.

O'Kane, Carl J.

Objective: To determine whether slow or fast bandaid removal is less painful. 



Design, setting and participants: A prospective, randomised, crossover trial was carried out at James Cook University, Townsville. Participants were healthy volunteers

from Years 2 and 3 of the James Cook University medical school program.



Interventions: Medium-sized bandaids were applied bilaterally in three standard body locations and removed using slow and fast techniques.



Main outcome measures: Pain scores were assessed using an 11-point verbal numeric pain scale.



Results: 65 participants were included in the study. The overall mean pain score for fast bandaid removal was 0.92 and for slow bandaid removal was 1.58. This represents a

highly significant difference of 0.66 (P < 0.001).



Conclusion: In young healthy volunteers, fast bandaid removal caused less pain than slow bandaid removal

ResearchOnline at James Cook University

CHR ISTMAS OFFERINGSFast versus slow bandaid removal: a randomised trialJeremy S Furyk, Carl J O’Kane, Peter J Aitken, Colin J Banks and David A KaultThe Medical Journal of Australia ISSN: 0025-729X 7/21 December 2009 191 11/12 682-683©The Medical Journal of Australia 2009www.mja.com.auChristmas OfferingsSimple dressings are known by many differ-ent nam s, such s sticking plasters. Band-Aidis one of the most popular and best-sellingbrands of simple dressings worldwide; it isused so frequently both in domestic andhealth care settings that the brand name hasbeen adopted for generic usage.or suchroninformcipanalthoParticfits to682 MJAABSTRACTObjective: To determine whether slow or fast bandaid removal is less painful.Design, setting and participants: A prospective, randomised, crossover trial was carried out at James Cook University, Townsville. Participants were healthy volunteers from Years 2 and 3 of the James Cook University medical school program.Interventions: Medium-sized bandaids were applied bilaterally in three standard body locations and removed using slow and fast techniques.Main outcome measures: Pain scores were assessed using an 11-point verbal numeric pain scale.Results: 65 participants were included in the study. The overall mean pain score for fast bandaid removal was 0.92 and for slow bandaid removal was 1.58. This represents a highly significant difference of 0.66 (P < 0.001).Conclusion:  In young healthy volunteers, fast bandaid removal caused less pain than MJA 2009; 191: 682–683slow bandaid removal.ppcowoA lying dressings to wounds is ammon practice throughout therld, both in and out of hospitals.At times, removing such dressings can bemore painful than the wound itself.1Research on dressing removal has oftenfocused on expensive new products2 and,although speed of dressing removal hasbeen controlled for in some studies2 (imply-ing that speed is a factor), we are not awareof any research directed specifically at differ-ent speeds of dressing removal. There areInternet sites addressing how to reduce thepain associated with removal of certainbrands of dressings, such as Band-Aid(Johnson & Johnson, New Brunswick, NJ,USA) (eg, http://www.wikihow.com/Remove-a-Band-Aid); however, there is noconsensus on the issue of speed.The pain of dressing removal is thought tobe related to the mechanical stripping of thestratum corneum from the underlying epider-mal and dermal cells.3 However, the percep-tion of pain is complex — it is a multifactorialexperience influenced by culture, previouspain events, beliefs, mood and ability to cope.4The two most common methods of bandaidremoval are slow bandaid removal (SBAR) andfast bandaid removal (FBAR). Proponents ofthe slow technique advocate that minimisingthe noxious stimulus is preferable, despiteexposing the individual to longer total time ofstimulus. With the fast technique, shorterexposure to the noxious stimulus may beperceived as less painful, despite short intensestimulation of pain-perceiving nociceptors.We aimed to compare these two commonmethods of bandaid removal and to defini-tively answer the question: which method ofremoval, fast or slow, causes less pain?METHODSThe study was a prospective, randomised,crossover trial comparing FBAR with SBAR inhealthy volunteers. It was conducted on 4August 2009 at James CookUniversity, Townsville,Queensland.The study participants were a conveniencesample of healthy volunteers from the secondand third years of a 6-year, undergraduatemedical school program at James Cook Uni-versity. Inclusion criteria were age greater than18 years and ability to provide informed con-sent. Exclusion criteria included documentedspected allergy to adhesive dressings, andic pain or anxiety disorder. Writtened consent was obtained from all parti-ts. The participants were not coerced,ugh pizza was available for them.ipants were also made aware of the bene- humanity that the study would poten-tially provide.The brand of dressings used was Band-Aid(Johnson & Johnson); medium-sized dress-ings were used. These were not supplied bythe manufacturer. Dressings were appliedbilaterally in three standard body locations: theupper arm over the deltoid, the dorsum of thehand, and immediately superior to the medialmalleolus of the ankle. The participants wererandomly assigned sequentially numbereddata collection sheets in sealed opaque enve-lopes to determine which removal technique(FBAR or SBAR) would be tested first andwhich side of the body (left or right) would betested first. This sequence of bandaid removalwas maintained for all three locations in eachindividual participant. The random sequencewas determined by use of standard randomnumber tables. Data on age, sex, the particip-ants’ preconceptions about which methodwould be more painful, ethnicity and amountof body hair (assessed by using a 5-point scale,where 1 represented “no hair” and 5 repre-sented “most hairy”) were also collected.The two operators (C JO and CJB) attendeda 1-hour training session on dressing removalbefore commencement of the study. FBARconsisted of a single rapid movement, whereasSBAR consisted of dressing removal over a2-second period. One of us (JSF) observed alldressing removals to ensure consistency oftechnique.The primary outcome was pain scoreassessed using an 11-point, verbal numericpain scale, where 0 represented “no pain” and10 represented “worst pain imaginable”.Immediately after dressing removal, particip-ants were asked to rate the pain experienced.Data were entered into an Excel spreadsheet(Microsoft, Redmond, Wash, USA) and ana-lysed using Public Domain Statistics (JamesCook University, Townsville, Qld) and SPSSversion 14.0 (SPSS, Chicago, Ill, USA). Theaverage differences in pain scores, for SBARversus FBAR and for each individual partici-pant, were tested for significance. The overalloutcome was assessed using a single-sample ttest, to test whether the measures for individu-als were significantly different from zero(equivalent to a paired-sample t test). Otherresults were analysed using independent-sam-ple t tests and simple regression.A minimum sample size of 60 was neededto demonstrate a difference in mean overallpain scores of 0.5 between SBAR and FBAR,assuming a variance in the data to be analysedof 2, statistical power of 80% (type 2 error of20%) and an alpha value of 0.05. We thought• Volume 191 Number 11/12 • 7/21 December 2009CHR ISTMAS OFFERINGSpain scores for dressing removal would be atthe lower end of the pain scale and, althoughthe level of clinical significance in this range isnot known, we assumed a change of 0.5 to beclinically significant.The study protocol was approved by theTownsville Health Service District InstitutionalEthics Committee and conforms to the provi-sions of the Declaration of Helsinki.5 Therewas no manufacturer involvement in the study.RESULTSSixty-five participants were included in thestudy, of whom 35 were female (54%) and 48were of European ancestry (74%); the meanage of participants was 20.1 years (range 18–30 years). Most participants (49/65; 75%)believed that SBAR would be more painfulthan FBAR. The mean body hair score for menwas 2.1 and the mean for women was 1.3(P<0.001).The mean overall pain score for FBAR was0.92, and for SBAR was 1.58. This represents ahighly significant difference of 0.66(P<0.001). However, FBAR was not associ-ated with lower pain scores than SBAR for allparticipants. An analysis of individual predic-tor variables indicated that low body hairscore, preconception that SBAR would bemore painful than FBAR, and testing FBARbefore SBAR were all significantly related tolower pain scores for FBAR compared withSBAR (P=0.01, P=0.03 and P=0.03, respec-tively). Increasing age, operator and ethnicitywere less convincingly related (P=0.11, P=0.08 and P=0.10, respectively). There was noappreciable difference due to the left or rightside being tested first. Mean overall pain scoresfor women were significantly lower than formen (0.91 v 1.64, respectively; P<0.001).DISCUSSIONOur results show that FBAR was less painfulthan SBAR. This is consistent with the precon-ceptions of most of our sample. A high bodyhair score was, not surprisingly, associatedwith higher pain scores, and it seemed thatpreconceptions also had an appreciable effect.Several other aspects of our data may requirefurther investigation. The pain experience is acomplex and incompletely understood processthat incorporates many aspects of patients’social and cultural beliefs, as well as previousexperiences.4 Our observation that preconcep-tions were associated with pain scores shouldnot therefore be surprising.The association between increasing age andhigher pain scores is interesting, although thisdid not reach statistical significance. Our sam-ple consisted of young healthy adults; there-fore our results may not be applicable to otherage groups such as children and older people.The operator effect was also interesting.Although FBAR was associated with lowerpain scores in participants belonging to bothoperator groups, the fact that the scores weredifferent between groups suggests that removalof dressings may be operator-dependent, andthere may be skilled bandaid removers andless-skilled or unskilled bandaid removers.The lower mean pain score for women maybe due to a higher pain tolerance, althoughmen did have a significantly higher body hairscore.It is also important to note that our parti-cipants were healthy volunteers with nowounds, thus pain was associated with minorskin damage only and not associated withwound pain. These results would therefore notbe applicable to patients with wounds, partic-ularly chronic wounds and ulcers, which mayadhere to Band-Aid brand dressings and otherbrands of simple dressings.Our study had other limitations. Theseincluded the inability to blind the participants(in terms of which removal technique andwhich side of the body would be tested first)and preconceived ideas regarding the tech-nique that would be more painful, both ofwhich may have biased our results. However,the use of randomisation and a crossoverdesign should have minimised this inherentbias. In addition, scoring pain is an imprecisescience and there is no perfect pain assessmenttool. The verbal numeric pain scale is a com-monly used pain assessment tool and has beenvalidated for use in emergency settings.6 It ispossible that it may be less reliable and repro-ducible at the lower ends of the pain scale.We used human rather than mechanicaloperators to conduct both SBAR and FBAR.Although this may have led to human errorand bias, we chose this method to increaseexternal validity and ability to generalise ourresults. Although mechanised dressing remov-ers may be available in the research setting,they are unlikely to become widely availablefor routine use in the home or hospital. There-fore use of mechanised dressing removerswould have limited the conclusions that couldbe drawn from our study. We would have likedto have recorded video samples of SBAR andFBAR to ensure standardisation of removalspeed, but this was not possible owing toinsufficient budget.In a sample of young healthy volunteers, wefound FBAR caused less pain than SBAR. Ahigh body hair score and preconception thatSBAR would be more painful were also posi-tively associated with pain scores. Our resultsmay not be applicable to different types ofdressings or specific wounds, and furtherresearch is needed to address these issues.However, we hope that our results will assistparents, carers and health care staff in adoptingthe least painful method of bandaid removal.COMPETING INTERESTSNone identified.AUTHOR DETAILSJeremy S Furyk, MB BS, FACEM, MPHTM, Emergency Physician,1 and Associate2Carl J O’Kane, FACEM, Emergency Physician,1 and Associate2Peter J Aitken, MB BS, FACEM, EMDM, Emergency Physician,1 Associate,2 Associate Professor,3 and Noel Stevenson Fellow4Colin J Banks, MB BS, FACEM, Emergency Physician,1 and Associate2David A Kault, MB BS, BSc, PhD, Senior Lecturer51 Department of Emergency Medicine, Townsville Hospital, Townsville, QLD.2 Townsville Institute of Research in Emergency Departments (TIRED), Townsville, QLD.3 Anton Breinl Centre, James Cook University, Townsville, QLD.4 Queensland Emergency Medicine Research Foundation, Brisbane, QLD.5 School of Engineering and Physical Sciences, James Cook University, Townsville, QLD.Correspondence: jeremy_furyk@health.qld.gov.auREFERENCES1 Woo KY, Harding K, Price P, Sibbald G. Minimisingwound-related pain at dressing change: evi-dence-informed practice. Int Wound J 2008; 5:144-157.2 Dykes P, Heggie R. The link between the peelforce of adhesive dressings and subjective dis-comfort in volunteer subjects. J Wound Care2003; 12: 260-262.3 Dykes P, Heggie R, Hill S. Effects of adhesivedressings on the stratum corneum of the skin. JWound Care 2001; 10: 7-10.4 Australian and New Zealand College of Anaes-thetists and Faculty of Pain Medicine. Acute painmanagement: scientific evidence (second edi-tion). Melbourne: ANZCA, 2005. http://www.nhmrc.gov.au/_files_nhmrc/file/publica-tions/synopses/cp104.pdf (accessed Aug 2009).5 World Medical Association Declaration of Hel-sinki — Ethical Principles for Medical ResearchInvolving Human Subjects. http://www.wma.net/en/30publications/10policies/b3/index.html(accessed Sep 2008).6 Holdgate A, Asha S, Craig J, Thompson J. Com-parison of a verbal numeric rating scale with thevisual analogue scale for the measurement ofacute pain. Emerg Med (Fremantle) 2003; 15: 441-446.(Received 3 Oct 2009, accepted 19 Oct 2009) ❏MJA • Volume 191 Number 11/12 • 7/21 December 2009 683

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Fast versus slow bandaid removal: a randomised trial

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Fast versus slow bandaid removal: a randomised trial

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