Effect of Virtual Reality on Adolescent Pain During Burn Wound Care

Abstract

The objective of this study was to compare the effect of virtual reality to passive distraction and standard care on burn treatment pain in adolescents.This single-blinded, randomized controlled study enrolled 30 adolescents who were 10 to 17 years of age from the burn clinic of a large children's hospital. After providing informed consent/assent, these participants were randomly assigned to one of three groups during wound care: standard care, passive distraction watching a movie, or virtual reality (VR) using a tripod-arm device rather than an immersive helmet. Before wound care, participants completed the Spielberger's State-Trait Anxiety Inventory for Children and Pre-Procedure Questionnaire while blinded to group assignment. A total of 28 participants completed the study and rated treatment pain after wound care by using the Adolescent Pediatric Pain Tool and completed a Post-Procedure Questionnaire. The VR group reported less pain during wound care than either the passive distraction or standard care group as determined by multivariable linear regression adjusted for age, sex, preprocedure pain, state anxiety, opiate use, and treatment length. The VR group was the only group to have an estimated decrease in pain perception from baseline preprocedure pain to procedural pain reported. Adolescents pretreated with opiate analgesics and female adolescents reported more pain during wound care.This between-subjects clinical study provides further support for VR, even without requiring wearing of an immersive helmet, in lessening burn wound care pain in adolescents. Passive distraction by watching a movie may be less effective in reducing treatment pain. Additional between-subjects randomized controlled trials with larger samples of children and during other healthcare treatments may further support VR's effectiveness in pediatric procedural pain management.

Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective

“…Trials during laceration repair for children in the ED (Ha & Kim, 2013) and during physical therapy for children and adolescent burn patients (Schmitt et al, 2011) showed improved pain relief with distraction versus no distraction. Sophisticated multimodal distraction (e.g., educational device, virtual reality) decreased pain intensity relative to standard distraction (e.g., television, videos, stories, toys, soothing) in studies of children or adolescents with burns (Brown, Kimble, Rodger, Ware, & Cuttle, 2014; Jeffs et al, 2014; Kipping, Rodger, Miller, & Kimble, 2012; Miller, Rodger, Kipping, & Kimble, 2011). An abundance of evidence supports the use of distraction techniques for reducing pain and potentially reducing the need for anxiolytics and opioids, particularly after burns (Drahota et al, 2012; Jeffs et al, 2014).…”

“…Distraction techniques (e.g., movies, virtual reality) focus patient attention and limit the nervous system's ability to process pain stimuli (Jeffs et al, 2014). These techniques have been shown to effectively relieve pain in adults (Drahota et al, 2012), and other studies have focused on their efficacy in children and adolescents.…”

Assessing the feasibility of implementing low-cost virtual reality therapy during routine burn care

“…[15,16]). Specifically, VR technology has been used successfully in burn care settings, with results of multiple studies indicating reductions in pain associated with routine burn-related procedures such as wound care [17], wound debridement [18], dressing changes [19], and physical therapy [20,21]. …”

An assessment of early Child Life Therapy pain and anxiety management: A prospective randomised controlled trial

“…It has been well established b u r n s x x x ( 2 0 1 5 ) x x x -x x x that the use of distraction during medical procedures significantly reduces pain and anxiety experienced by children [9,19]. There have been multiple studies confirming the effectiveness of specific CLT devices and techniques in burns; for example virtual reality, music therapy, or use of the Ditto TM device (Diversional Therapy Technologies, Brisbane, Australia) [7,10,11,[20][21][22][23]. In our Burn Unit, not only have we found that specific techniques and devices appear beneficial, but the role of a CLTP has anecdotally also had a significant impact on the reduction of pain and anxiety experienced by children with acute burns.…”