Immersive Virtual Reality as an Adjunctive Non-opioid Analgesic for Pre-dominantly Latin American Children With Large Severe Burn Wounds During Burn Wound Cleaning in the Intensive Care Unit: A Pilot Study

Abstract

Background/Aim: Using a within-subjects, within-wound care design, this pilot study tested for the first time, whether immersive virtual reality (VR) can serve as an adjunctive non-opioid analgesic for children with large severe burn wounds during burn wound cleaning in the ICU, in a regional burn center in the United States, between 2014–2016. Methods: Participants included 48 children from 6 years old to 17 years of age with >10% TBSA burn injuries reporting moderate or higher worst pain during no VR on Day 1. Forty-four of the 48 children were from developing Latin American countries. Patients played adjunctive SnowWorld, an interactive 3D snowy canyon in virtual reality during some portions of wound care, vs. No VR during comparable portions of the same wound care session (initial treatment condition randomized). Using Graphic Rating scales, children's worst pain ratings during “No VR” (treatment as usual pain medications) vs. their worst pain during “Yes VR” was measured during at least 1 day of wound care, and was measured for up to 10 study days the patient used VR. Results: VR significantly reduced children's “worst pain” ratings during burn wound cleaning procedures in the ICU on Day 1. Worst pain during No VR = 8.52 (SD = 1.75) vs. during Yes VR = 5.10 (SD = 3.27), t (47) = 7.11, p < 0.001, SD = 3.33, CI = 2.45–4.38, Cohen's d = 1.03 (indicating large effect size). Patients continued to report the predicted pattern of lower pain and more fun during VR, during multiple sessions. Conclusion: Immersive virtual reality can help reduce the pain of children with large severe burn wounds during burn wound cleaning in the Intensive Care Unit. Additional research and development is recommended.

Virtual Reality Analgesia With Interactive Eye Tracking During Brief Thermal Pain Stimuli: A Randomized Controlled Trial (Crossover Design)

“…Although there is growing evidence that VR can be effective for reducing acute pain during painful medical procedures (Hoffman et al, 2019), the non-pharmacologic mechanism of how VR reduces pain is not fully understood and is an important research topic. According to Ballantyne (2018, p. s25) "The conscious perception of pain depends on the conversion of nociception to perception.…”

“…Despite giving patients powerful analgesia pain medications shortly before wound care, patients typically remain conscious during burn wound care, pain during non-surgical wound debridement of severe burn wounds is often severe to excruciating, and wound care procedures are repeated frequently. Children with large burns typically have their burn wounds cleaned several days per week, during several weeks of hospitalization (Hoffman et al, 2019).…”

“…In previous clinical studies, virtual reality has typically been used in addition to traditional pain medications to help reduce the pain experienced by patients during painful severe burn wound cleaning sessions (Hoffman et al, 2000(Hoffman et al, , 2004a(Hoffman et al, , 2019Maani et al, 2011a,b;Kipping et al, 2012;Faber et al, 2013;Jeffs et al, 2014;Khadra et al, 2018;McSherry et al, 2018) 1 . In a military study, while in virtual reality, soldiers with combat-related burn injuries spent less time thinking about their pain, patients reported reductions in worst pain intensity and reductions in the emotional component of pain (pain unpleasantness) during VR, and patients reported having more fun when they went into virtual reality during medical procedures, compared to standard of care pain medications alone (Maani et al, 2008(Maani et al, , 2011a.…”

“…One clinical research study recently explored the use of virtual reality to help reduce the pain of pediatric patients with large severe burn injuries during burn wound cleaning sessions in the intensive care unit of a regional pediatric burn center (Hoffman et al, 2019). Although patients reported large and significant reductions in pain during burn wound care, the researchers recommended that stronger versions of virtual reality need to be developed, in order to better distract patients experiencing such high levels of pain during burn wound cleaning.…”

“…Interacting with the virtual world increases the immersiveness of the VR system, potentially increasing the amount of attention drawn into the virtual world (e.g., Wender et al, 2009). The results of these laboratory studies have helped guide the design of effective VR analgesia systems, e.g., fMRI magnet-friendly wide field of view VR helmets, e.g., Hoffman et al (2004bHoffman et al ( , 2007 and the development robot-like arm VR goggle holders for severe burn patients (Maani et al, 2008(Maani et al, , 2011aHoffman et al, 2019).…”