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Smartphone Virtual Reality Games Reduce Pain During Burn Dressing Changes

(Reuters Health) – Pediatric burn patients who play smartphone virtual reality games during burn dressing changes report less pain than those who receive standard care, a clinical trial suggests.

Researchers randomized 90 pediatric burn patients 1:1:1 to receive active virtual reality games, passive virtual reality exposure that didn’t have a game component, or to join control group to receive standard distraction tools such as music, books, tablets, or talking. The main goal of the study was to assess differences in self-reported pain using a visual-analog scale (VAS, 0-100, higher scores indicating worse pain).

Children who played active virtual reality games reported significantly lower overall pain scores (VAS 24.9) than patients in the control group (VAS 47.1). Kids in the active virtual reality group also had lower peak pain scores (VAS 27.4) than children in the passive virtual reality (VAS 47.9) and control groups (VAS 48.8).

“According to the cognitive-affective model of pain, virtual reality gaming will pose an attention load on a person’s cognitive system so children will pay less attention to pain associated with burn dressing changes,” said lead study author Dr. Henry Xiang, director of the Center for Pediatric Trauma Research at Nationwide Children’s Hospital in Columbus, Ohio.

“Thus, they will be less likely than the standard care group to feel the pain,” Dr. Xiang said by email.

The mean age of children in the study was 11.3 years, and most had second degree burns (90%). The three groups were similar in mean age, sex distribution, percentage of total body surface area burned, anxiety levels, and child and caregiver expectations for how fun or helpful virtual reality might be.

Beyond its small size, another limitation of the study is that participants were seen in an outpatient setting where burn dressing changes typically take less than 30 minutes, so the results are not generalizable to other settings with longer dressing changes, the authors note in JAMA Network Open.

Another limitation of the study is that researchers only tested the impact of virtual reality games with one dressing change, and it’s not clear if results would persist after multiple dressing changes. Patients and caregivers also weren’t blinded to the intervention they received, and it’s possible that this biased the results.

However, virtual reality distraction techniques for pain management after burn injury have been effective in multiple studies dating back 20 years, said Dr. Tina Palmieri, burn division chief, professor and director of the Firefighters Burn Institute Burn Center at the University of California, Davis in Sacramento, California.

While earlier renditions of virtual reality technology were cumbersome and expensive, prohibiting widespread use, newer versions using smartphone technology are far more affordable and simpler to use, Dr. Palmieri, who wasn’t involved in the study, said by email.

“The smart phone is a familiar technology to clinicians, families, and children, which should help improve acceptability,” Dr. Palmieri said. “Virtual reality adds another tool to the pain treatment toolbox.”

SOURCE: JAMA Network Open, online June 21, 2021.

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