Virtual Reality Analgesia for Children With Large Severe Burn Wounds During Burn Wound Debridement

Abstract

The objective of this study was to compare the effect of adjunctive virtual reality vs. standard analgesic pain medications during burn wound cleaning/debridement. Participants were predominantly Hispanic children aged 6–17 years of age, with large severe burn injuries (TBSA = 44%) reporting moderate or higher baseline pain during burn wound care. Using a randomized between-groups design, participants were randomly assigned to one of two groups, (a) the Control Group = pain medications only or (b) the VR Group = pain medications + virtual reality. A total of 50 children (88% Hispanic) with large severe burns (mean TBSA > 10%) received severe burn wound cleaning sessions. For the primary outcome measure of worst pain (intensity) on Study Day 1, using a between groups ANOVA, burn injured children in the group that received virtual reality during wound care showed significantly less pain intensity than the No VR control group, [mean worst pain ratings for the No VR group = 7.46 (SD = 2.93) vs. 5.54 (SD = 3.56), F(1,48) = 4.29, < 0.05, MSE = 46.00]. Similarly, one of the secondary pain measures, “lowest pain during wound care” was significantly lower in the VR group, No VR = 4.29 (SD = 3.75) vs. 1.68 (2.04) for the VR group, F(1,47) = 9.29, <0.005, MSE = 83.52 for Study Day 1. The other secondary pain measures showed the predicted pattern on Study Day 1, but were non-significant. Regarding whether VR reduced pain beyond Study Day 1, absolute change in pain intensity (analgesia = baseline pain minus the mean of the worst pain scores on Study days 1–10) was significantly greater for the VR group, F(1,48) = 4.88, p < 0.05, MSE = 34.26, partial eta squared = 0.09, but contrary to predictions, absolute change scores were non-significant for all secondary measures.

Interacting with virtual objects via embodied avatar hands reduces pain intensity and diverts attention

“…Another limitation is that the current study is an analog laboratory pain study, with only brief thermal pain stimuli and brief VR treatment durations. Whether the current results generalize to clinical settings (e.g., severely burned children during 20 min burn wound debridement sessions) is an important research topic for future clinical studies with patients during painful medical procedures, e.g., 2 , 58 .…”

Impact of Virtual Reality Technology on Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-Analysis

“…When looked into different VR interventions, active VR yields medium to large effect sizes ranging from Cohen's d of 0.39 (Xiang et al, 2021) to 1.03 (Hoffman et al, 2019), which was similar to the studies using Multi-Modal Distraction (Cohen's d ranging from 0.4 to 1.72). VR was found to be effective in reducing self-reported pain when compared to standard distraction (e.g., TV, videos, books, and toys (Miller et al, 2011;Kipping et al, 2012;Brown et al, 2014)), as well as standard medication care (Hoffman et al, 2019;Hoffman et al, 2020).…”

“…Active VR refers to the VR games that involves interactions of the patients to the virtual environment. In Hoffman et al (2019Hoffman et al ( , 2020 and Jeffs et al (2014) studies, VR Snow World was adopted and found to be effective in alleviating pain during the wound care (Jeffs et al, 2014;Hoffman et al, 2019;Hoffman et al, 2020). The snowy VR environment was designed with special considerations given to pediatric burn patients.…”

“…Standard care. The majority of the included studies employed standard pain medication care as a comparison group/exposure (Khadra et al, 2018;Hoffman et al, 2019;Hoffman et al, 2020;Khadra et al, 2020;Le May et al, 2021).…”

“…Hoffman et al (2019Hoffman et al ( , 2020 studies, most of which were from Latin American(Hoffman et al, 2019;Hoffman et al, 2020). Adolescent-aged patients comprised the comparison groups inKipping et al (2012),Jeffs et al (2014), and LeMay et al (2021) studies(Kipping et al, 2012;Jeffs et al, 2014;Le May et al, 2021).…”