Researchers at the National Children’s Hospital have reported the use of smartphone-based virtual reality games (VR) for children undergoing dress changes for burns. This work builds on the existing body that explores alternative approaches to reducing pain through music, hypnosis, toys, and VR.

The American Burn Association says burns affect about 250,000 children in the United States each year. In addition to the burn itself, patients suffer from pain associated with changes in dress, which is also exacerbated by anxiety and anticipation.

Opioids are an effective treatment for pain associated with burns, but their side effects can be devastating. It is this that has increased interest in alternative approaches to pain reduction.

New research was released on June 21 this year JAMA network open.

The team included Henry Xiang, MD, PhD, MBA, and several other colleagues. The team reported on the use of smartphone-based VR games during dress changes in children.

Dr. Xiang is also a professor of pediatrics and epidemiology at the National Children’s Hospital and director of the Center for Pediatric Trauma Research.

“The VR game based on smartphones was very effective in reducing patient-reported pain,” says Dr. Xiang.

Pilot study

The pilot study was designed as a randomized clinical trial, and the study team divided children aged 6 to 17 years into three treatment groups: active VR, passive VR, and standard care. The majority of patients had secondary burns and received outpatient treatment for burns between December 2016 and January 2019.

The VR game used is called “Virtual River Cruise” and is specifically designed for research by the Nationwide Department of Information Research and Innovation in Children’s Research.

“Two factors were considered in the design of the game,” says Dr. Xiang. “The first factor was the snow, the cool environment at play. The second factor was cognitive processing to encourage active engagement.”

Patients used the game on a smartphone or headset during their dressing, which lasted about five or six minutes.

Patients in the active VR group were actively involved in the game. To stay still while playing the game, patients tilted their heads to aim at the target. Patients in the passive VR group watched the game only without interacting.

Reduction of pain and opioid dependence

Nurses and patients reported the pain and subjective experience they observed in post-intervention studies, and nurses evaluated the clinical benefit of the game.

The lowest overall pain score was in patients in the active VR group, and most patients and caregivers reported a positive experience with the game.

According to nurses, the game is clinically useful in outpatient care. Prior to the use of VR, computer games were used in this process, but their mass was not clinically practical.

“Smartphones are easy to use, and most families have them,” said Dr. Xiang.

Dr. Xiang believes that VR games can also be played at home to relieve pain because they are easy to use and effective.

“Pediatric cremation patients still need dress changes at home after the hospital discharge, and these changes can be very painful,” said Dr. Xiang.

Dr. Xiang is also leading a research project funded by the Ohio Public Security Department’s emergency department. The aim of the project is to evaluate the feasibility and effectiveness of VR games in reducing pain during a burn change at home.

According to Dr. Xiang, the ongoing opioid crisis is another reason to explore these alternative treatments.

“The direction of future research is to assess whether VR games running on smartphones have an opioid-saving effect,” says Dr. Xiang.


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