Researchers at Nationwide Children’s Hospital have reported the use of virtual reality games (VR) on smartphones by pediatric patients undergoing dressing changes for burn injuries. This work builds on an existing body exploring alternative approaches to pain relief through music, hypnosis, toys and VR.
The American Burn Association reports that approximately 250,000 children in the United States are affected by burns each year. In addition to the burn itself, patients suffer from pain related to dressing changes, which is also exacerbated by fear and anticipation.
Opioids are an effective treatment for burn-related pain, but their side effects can be devastating. This has led to an increased interest in alternative approaches to pain reduction.
The new study was published June 21 in JAMA Network Open.
The team included Henry Xiang, MD, MPH, PhD, MBA, along with several other colleagues. The team reported the use of smartphone-based VR games during dressing changes in pediatric patients.
dr. Xiang is also a professor of pediatrics and epidemiology at Nationwide Children’s Hospital and director of the Center for Pediatric Trauma Research.
“The smartphone-based VR game was very effective in reducing patient-reported pain,” said Dr. Xiang.
The pilot study
The pilot study was designed as a randomized clinical trial and the research team divided children aged 6 to 17 years into three treatment groups: active VR, passive VR and standard care. Most patients had second-degree burns and received outpatient burn care between December 2016 and January 2019.
The VR game used is called ‘Virtual River Cruise’ and is specially designed for the research by the Nationwide Children’s Research Information Solutions and Innovation Department.
“The game was designed with two factors in mind,” explains Dr. Xiang out. “The first factor was a snowy, cooling environment within the game. The second factor was cognitive processing to encourage active engagement.”
The patients used a smartphone or headset to play the game during their dressing changes, which lasted about five to six minutes.
The patients who were in the active VR group were actively involved in the game. To stay still while playing the game, the patients tilted their heads to aim at a target. The patients who were in the passive VR group only watched the game with no interaction.
Reducing pain and dependence on opioids
Caregivers and patients reported their perceived pain and subjective experience in post-intervention surveys, and nurses evaluated the clinical usefulness of the game.
The lowest overall pain score came from the patients in the active VR group, and most patients and caregivers reported a positive experience with the game.
According to the nurses, the game is clinically useful in the outpatient setting. Prior to the use of VR, computer-based games were used in this process, but their size was not clinically practical.
“Smartphones are easy to use and most families have them,” says Dr. Xiang.
dr. Xiang believes that the VR games can also be played at home to relieve pain because they are easy to use and effective.
“Paediatric burn patients still need dressing changes after hospital discharge, and these changes can be very painful,” said Dr. Xiang.
dr. Xiang is also leading a research project funded by the Ohio Department of Public Safety’s Emergency Medical Service Division. The project aims to evaluate the feasibility and efficacy of VR games in reducing pain while changing burns at home.
According to Dr. Xiang, the ongoing opioid crisis is another reason to look at these alternative treatments.
“The future direction of research is to evaluate whether smartphone-based VR games have an opioid-sparing effect,” said Dr. Xiang.