Transient Reductions in Postoperative Pain and Anxiety with the Use of Virtual Reality in Children

Abstract

Objective Virtual reality (VR) is a promising method to manage pain. Distraction-based VR (VR-D) is thought to reduce pain by redirecting attention. While VR-D can reduce pain associated with acutely painful procedures, it is unclear if VR-D can reduce pain after surgery. We assessed the ability of a single VR-D session to decrease postoperative pain and anxiety and explored if pain catastrophizing and anxiety sensitivity influenced these outcomes in children following surgery. Design Single-center, prospective, pilot study Setting Cincinnati Children’s Hospital Medical Center (CCHMC) Subjects 50 children (7-21 years) with postoperative pain followed by the Acute Pain Service Methods Patients received one VR-D session following surgery. Prior to the session, patients completed pain catastrophizing (PCS-C) and anxiety sensitivity (CASI) questionnaires. Primary outcome consisted of changes in pain intensity following VR-D (immediately, 15, and 30 minutes). Secondary outcomes included changes in pain unpleasantness and anxiety. Results VR-D use was associated with a decrease in pain intensity immediately and 15-minutes after VR-D. Reductions in pain unpleasantness were observed up to 30 minutes following VR-D. VR-D was also associated with a reduction in anxiety immediately and at 15-minutes. While patients with higher pain catastrophizing had higher baseline pain intensity and unpleasantness, they did not show larger pain reductions following VR-D compared to those with lower pain catastrophizing. Conclusions VR-D may be beneficial in transiently reducing pain intensity, unpleasantness, and anxiety in children with postoperative pain. This study informs design of larger, randomized, controlled study assessing VR-D for acute postoperative pain and anxiety management.

Effect of Virtual Reality on Pain Management and Opioid Use Among Hospitalized Patients After Head and Neck Surgery

“…Specht et al performed a randomized clinical trial and found that VR was associated with reduced postoperative pain scores compared with tablet use among pediatric patients. Olbrecht et al also found VR to reduce pain and anxiety among pediatric patients after surgery. A small, noncontrolled study by Mosso-Vázquez et al reported reduced postoperative pain as well as psychological stress among patients using VR after cardiac surgery.…”

“…In the general inpatient setting, VR use has shown to be feasible and associated with pain reduction compared with a 2-dimensional (2D) control . However, there has been limited study of VR in the setting of postoperative pain management . There are different types of VR content that may influence the sensory experience .…”

Application of behavioral economic strategies to enhance recruitment into a pediatric randomized clinical trial for postoperative pain relief: A randomized clinical trial

“…Additionally, past pilot studies that led to the development of VR-BF had an enrollment rate of 43% when patients were approached after surgery. 16,17 Eligible patients declined to enroll due to feeling tired, being in…”

“…To our knowledge, this is one of the first randomized trials to test the impact of behavioral economics on the recruitment of pediatric patients into a randomized clinical trial. Additionally, past pilot studies that led to the development of VR‐BF had an enrollment rate of 43% when patients were approached after surgery 16,17 . Eligible patients declined to enroll due to feeling tired, being in too much pain, or having other clinical needs postoperatively.…”

Paediatric pain management: from regional to virtual

“…For children, virtual reality has been found to be well tolerated and more effective in decreasing pain during the immediate postoperative period than iPad use [61 ▪▪ ]. A 2021 study by Olbrecht et al [62 ▪ ] looking at patients aged 7–12 years found that VR-D supported transient reductions in pain intensity, unpleasantness and anxiety in children with postoperative pain. Further, pain reductions were consistent among patients with higher vs. lower pain catastrophizing.…”