Virtual Reality in Pediatric Pain Management

Using Guided-Relaxation Based Virtual Reality to Manage Post-Surgical Pain and Anxiety in Children

By Keith T. O’Conor, BS and Vanessa A. Olbrecht, MD, MBA
Cincinnati Children’s Hospital Medical Center
Department of Anesthesiology
University of Cincinnati
Cincinnati, Ohio

Virtual Reality (VR) is a multimodal (visual, auditory, tactile and olfactory) system that transports users into a fully immersive ‘virtual world’ by using a combination of a head-mounted display, headphones, and a device for manipulation/navigation of the virtual environment, such as head-tracking systems. From 1970-1990, early inceptions of VR were used for military training, medical and flight simulation, and even automobile design. Since 1990, VR has entered popular culture, and has been used for its entertainment value. What was once entertainment or training equipment, has rapidly gained attention as a complementary pain management strategy. VR offers an innovative method to deliver nonpharmacological pain management.

Children undergo painful medical procedures every day, but very few non-pharmaceutical interventions have been found to successfully manage their pain. Virtual Reality (VR) is a safe, nonpharmacologic tool that has the potential to decrease pain and opioid consumption in patients with postoperative pain. Distraction-based VR (VR-D) using immersive games to redirect attention has shown short-term pain reductions in various settings. However, in order to create lasting pain reduction, VR-based strategies must go beyond distraction. Guided relaxation-based VR (VR-GR) integrates guided relaxation with VR for nonpharmacologic management of pain.

We recently completed a pilot study at Cincinnati Children’s Hospital Medical Center to determine if VR-GR could be used to decrease acute postoperative pain intensity, pain unpleasantness, and anxiety in the pediatric population after surgery. Over a 9-month period, we enrolled 51 patients with postoperative pain being followed by the Acute Pain Service to participate in a single, 10-minute, VR-GR session after surgery using the application “Mindful Aurora.” This application “transports” users to an alpine meadow where 10-minute narrative guides patients through a relaxing nature scene and has them sync their breathing with elements in the virtual world.

By comparing baseline measurements of pain intensity, pain unpleasantness, and anxiety to measurements taken after the single postoperative session of VR-GR, our analysis demonstrated small to moderate effects of VR-GR on pain intensity and pain unpleasantness and mild effects on anxiety. These changes remained significant for up to 30 minutes following the VR-GR session.

Satisfaction with the VR experience was extremely high among patients and their families. Ninety-six percent of children said they would recommend VR to friends and family and 88% of patients believed that their child felt “calmer and less anxious after having used VR.” The acceptance of VR treatment among parents was also extremely high. According to the survey data, 100% of parents from the VR-GR would recommend VR to friends or family.

In summary, our pilot study demonstrated immediate and acute reductions in pain intensity, pain unpleasantness, and anxiety in children and adolescents after a short, single session of VR-GR therapy. This result has led to the development of our current randomized, clinical trial that compares VR-GR to distraction-based VR and a 360-degree video control. We will be measuring pain and anxiety outcomes as well as opioid and benzodiazepine use after surgery in order to gain further insight into the potential of VR-GR to reduce postoperative pain and opioid consumption.


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