Abstract

Background and aims:   Excessive pain during medical procedures is a worldwide medical problem. Most scald burns occur in children under 6, who are often undermedicated. Adjunctive Virtual Reality (VR) distraction has been shown to reduce pain in children aged 6-17, but little is known about VR analgesia in young children. This study tests whether desktop VR (VR Animal Rescue World) is able to reduce pain during burn wound cleaning/debridement of children aged between 10 months and up to and including 5 years olds during burn wound cleaning/debridement.

Methods:  A within-subject repeated measures design was used.  Each pediatric burn patient underwent burn wound cleaning/debridement under two conditions (treatment order randomized): (1) no distraction, (2) a large TV-based interactive desktop VR distraction customized for young children.   

Results:    A total of nine children with burn injuries were included in the clinical study aged 10 months to 5 years (mean age = 18 months old).   The mean burn size was 10% TBSA, range 2% to 22% TBSA).  Using non-parametric within subject Mann-Whitney tests, compared to treatment as usual (usual pain medications with no VR = 6.67, SD = 2.45), adjunctive VR Animal Rescue World (VR = 4.00, SD = 2.24) significantly (p = .01) reduced children’s pain during burn wound care by 40% on the observational FLACC pain scale.  In addition, anxiety during burn wound care was reduced by 34% (p = .08 NS) during VR Animal Rescue World (a non-significant reduction in anxiety, in the predicted direction, No VR = 20.56, (SD = 8.58), VR = 13.67, (SD = 8.93), using the observational Procedure Behavior Check List (PBCL) scale to measure anxiety.  VR also significantly increased patients’ joy during wound care on a zero to 5 Graphic Rating Scale primarily filled out by parents present during wound care.  Joy during wound care was rated as zero, “no joy” during No VR = 0.00 (SD = 0.00), and on the zero to five rating scale, and patients were described as “pleased” during VR, mean = 2.28 (SD = 1.11), p = .001, a highly significant increase in joy during VR.

Conclusion:  Using observational measures of pain, Desktop Virtual reality (VR) significantly reduced pain, and VR also significantly increased joy during wound care in children under six years old.  In light of these encouraging preliminary results, additional research and development of desktop VR distraction for young children during burn wound care is warranted.

Keywords: analgesia; non-pharmacologic; pain; pain management; pediatric; virtual reality.