The Efficacy of Virtual Reality in Pain Management in Pediatric Burn Patients.

Date of Award

Spring 2020

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Amanda Murphy, MMS, PA-C

Abstract

Introduction: Burn injuries are tissue damage that range in severity, and may affect as superficial as epidermis or as deep as the muscle and/or bone depending on the severity. One of the most common populations inflicted with burn injuries are children under the age of 15. Currently, the pain management used with burn patients include pain relief medications ranging from NSAIDS to narcotics; however, studies have shown that these methods are not sufficient in the management of pain, and that patients continue to suffer from long term effects such as PTSD and depression after procedures relating to burns. The use of immersive virtual reality has been successfully used as an aid in the management of pain (specifically in the pediatric population) in procedures such as IV placement, chemotherapy, and treatment for chronic headaches due to its ability to manipulate the person’s perception of reality. Therefore, this review attempts to assess the efficacy of immersive virtual reality in combination with pain medication on pain management in hospitalized children ages 2 months to 19 years with severe wounds/burns.

Method:A literature search was completed on Google Scholar, PubMed, and ClinicalKey in November of 2018. A total of seven articles consisting of randomized control trials, case-control trials, and case studies were selected based on publication date, sample population, and relevance to research topic.

Results: Based on this literature search four out of the seven articles were randomized control studies. The other studies were case control studies and case reports. Of the four randomized control studies, two of them found that the use of virtual reality when compared to the standard treatment had a statistically significant decrease in the level of pain the patients experienced. The other two randomized control studies both found an overall decrease in the perception of pain, however did not find a statistically significant difference. The two case reports both resulted in their subjects having a lesser perception of pain in the presence of the virtual reality. Lastly, the case control study found that there was a bimodal response to the virtual reality in that some patients it appeared to lower their level of pain and others it did not.

Discussion:These seven studies varied quite a bit among one another. Each study used different measuring tools, different sample sizes, different criteria for their subjects ages and level of injury, and largely different study designs. Ultimately, these differences made it difficult to compare and find similarities between these articles. However, the studies individually each had promising results regarding virtual reality.

Conclusion:There is some evidence that virtual reality will be a beneficial adjunctive therapy in the treatment of pediatric burn patients; however, more studies will have to be completed in the future for changes to be made in a clinical setting. Currently, the only treatment option in pediatric burn patients is pain medications, and it would be beneficial if there was a non-pharmacologic treatment option. One shortcoming to virtual reality is its cost, and this potentially will lead to problems with distribution in the future.

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The Efficacy of Virtual Reality in Pain Management in Pediatric Burn Patients.

Introduction: Burn injuries are tissue damage that range in severity, and may affect as superficial as epidermis or as deep as the muscle and/or bone depending on the severity. One of the most common populations inflicted with burn injuries are children under the age of 15. Currently, the pain management used with burn patients include pain relief medications ranging from NSAIDS to narcotics; however, studies have shown that these methods are not sufficient in the management of pain, and that patients continue to suffer from long term effects such as PTSD and depression after procedures relating to burns. The use of immersive virtual reality has been successfully used as an aid in the management of pain (specifically in the pediatric population) in procedures such as IV placement, chemotherapy, and treatment for chronic headaches due to its ability to manipulate the person’s perception of reality. Therefore, this review attempts to assess the efficacy of immersive virtual reality in combination with pain medication on pain management in hospitalized children ages 2 months to 19 years with severe wounds/burns.

Method:A literature search was completed on Google Scholar, PubMed, and ClinicalKey in November of 2018. A total of seven articles consisting of randomized control trials, case-control trials, and case studies were selected based on publication date, sample population, and relevance to research topic.

Results: Based on this literature search four out of the seven articles were randomized control studies. The other studies were case control studies and case reports. Of the four randomized control studies, two of them found that the use of virtual reality when compared to the standard treatment had a statistically significant decrease in the level of pain the patients experienced. The other two randomized control studies both found an overall decrease in the perception of pain, however did not find a statistically significant difference. The two case reports both resulted in their subjects having a lesser perception of pain in the presence of the virtual reality. Lastly, the case control study found that there was a bimodal response to the virtual reality in that some patients it appeared to lower their level of pain and others it did not.

Discussion:These seven studies varied quite a bit among one another. Each study used different measuring tools, different sample sizes, different criteria for their subjects ages and level of injury, and largely different study designs. Ultimately, these differences made it difficult to compare and find similarities between these articles. However, the studies individually each had promising results regarding virtual reality.

Conclusion:There is some evidence that virtual reality will be a beneficial adjunctive therapy in the treatment of pediatric burn patients; however, more studies will have to be completed in the future for changes to be made in a clinical setting. Currently, the only treatment option in pediatric burn patients is pain medications, and it would be beneficial if there was a non-pharmacologic treatment option. One shortcoming to virtual reality is its cost, and this potentially will lead to problems with distribution in the future.