Researchers at Nationwide Children’s Hospital have reported the use of smartphone-based virtual reality (VR) games by pediatric patients undergoing dressing changes for burn injuries. This work builds on an existing body that explores alternative approaches to pain reduction through music, hypnosis, toys and VR.
The American Burn Association reports that burn injuries affect around 250,000 children in the United States each year. Besides the burn injury itself, patients suffer from pain related to dressing changes, which is also worsened by anxiety and anticipation.
Opioids are an effective treatment against burn injury-related pain, but their side effects can be devastating. This is what has led to an increased interest in alternative approaches to pain reduction.
The new study was published on 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,” says Dr. Xiang.
The Pilot Study
The pilot study was designed as a randomized clinical trial, and the research team divided children, between the ages of 6 and 17, into three treatment groups: active VR, passive VR, and standard care. Most of the patients had second-degree burns and received outpatient care for burn injuries between December 2016 and January 2019.
The VR game used is called “Virtual River Cruise,” and it was designed specifically for the study by Nationwide Children’s Research Information Solutions and Innovation department.
“Two factors were considered for the game’s design,” explains Dr. Xiang. “The first factor was a snow, 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 around five to six minutes.
The patients that were in the active VR group actively engaged with the game. In order to remain still while playing the game, the patients tilted their head to aim a target. The patients that were in the passive VR group only watched the game without interacting.
Lowering Pain and Opioid Dependence
Caregivers and patients botn reported their perceived pain and subjective experience in post-intervention surveys, and nurses evaluated the game’s clinical utility.
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 during this process, but their bulkiness was not clinically practical.
“Smartphones are easy to use, and most families have them,” said Dr. Xiang.
Dr. Xiang believes the VR games can also be played at home to relieve pain since they are easy to use and effective.
“Pediatric burn patients still need dressing changes at home after hospital discharge, and these changes could be very painful,” said Dr. Xiang.
Dr. Xiang is also leading a research project that is funded by the Division of Emergency Medical Service of the Ohio Department of Public Safety. The project aims to evaluate the feasibility and efficacy of VR games in reducing pain during burn dressing changes at home.
According to Dr. Xiang, the ongoing opioid crisis is another reason to look into these alternative treatments.
“The future research direction is to evaluate whether smartphone-based VR games have an opioid-sparing effect,” says Dr. Xiang.