An Exploratory Study on the Effectiveness of Virtual Reality Analgesia for Children and Adolescents with Kidney Diseases Undergoing Venipuncture

Effectiveness of Virtual Reality for Managing Pain, Fear, and Anxiety in Children and Adolescents Undergoing Needle-Related Procedures: Systematic Review with Meta-Analysis

The most frequently performed invasive procedures in hospitals and healthcare centers are needle-related procedures, such as intravenous cannulation and phlebotomy, and they are identified as the major sources of pain, fear, and anxiety in children and adolescents. The objective of this systematic review was to evaluate the effectiveness of VR as a distraction measure to reduce pain, fear, and anxiety in children and adolescents undergoing needle-related invasive procedures. For this purpose, the CINAHL, Scopus, WOS, and Cochrane Library scientific databases were used. The protocol review was registered in PROSPERO (ID:42024563245), and inclusion and exclusion criteria were applied. Twenty-one studies were included in the systematic review, involving a total of 2663 participants. Significant differences favored the use of virtual reality for the control of pain intensity (WBFSpatients p = 0.001; MD = -1.83; 95% CI -2.93 to -0.72; WBFSparents p = 0.0002; MD = -2.61; 95% CI -4.00 to -1.23; WBFSnurses p = 0.0001; MD = -2.71; 95% CI -2.82 to -2.60; VAS/NRS p = 0.001, MD = -0.71; 95% CI -1.13 to -0.28), anxiety (CAMpatient p = 0.02, MD = -2.92; 95% CI -5.45 to -0.38; CAMparents p = 0.01, MD = -3.87; 95% CI -6.99 to -0.75) and fear (CFSpatients p = 0.0005, MD = -1.27; 95% CI -1.99 to -0.56; CFSparents p = 0.0005, MD = -1.33; 95% CI -2.08 to -0.58; and CFSnurses p = 0.04, MD = -1.13; 95% CI -2.24 to -0.03). However, high heterogeneity was noted. The use of virtual reality as a distraction appears to be a valuable strategy for reducing pain, fear, and anxiety during needle-related procedures, although further studies with higher methodological rigor, based on a standardized protocol, are needed.

Technology versus nostalgia; A randomized controlled trial of the effect of virtual reality and kaleidescop on pediatric pain, fear and anxiety management during immunization

BACKGROUND

Routine vaccination procedures, while crucial for public health, can induce pain, fear, and anxiety in children. Distraction techniques such as virtual reality and kaleidoscope have been proposed to alleviate these negative experiences during vaccinations.

OBJECTIVE

This study aimed to compare the effectiveness of virtual reality and kaleidoscope as distraction methods in reducing pain, fear, and anxiety during routine vaccination in children aged 48 months.

DESIGN

This randomized controlled trial allocated children aged 48 months receiving the measles-mumps-rubella vaccine into three groups: virtual reality (n = 42), kaleidoscope (n = 42), and control (n = 42).

SETTING(S)

The study was conducted in a pediatric clinic.

PARTICIPANTS

The study included a total of 126 children aged 48 months.

METHODS

Pain and fear levels were assessed by both researchers and children before and after the vaccination procedure, while anxiety was evaluated by children after vaccination. Pain was measured using the Wong Baker Faces Pain Rating Scale, fear with the Children's Fear Scale, and anxiety with the Child Anxiety Scale-State Version.

RESULTS

Post-vaccination pain, fear, and anxiety scores were significantly lower in the kaleidoscope group compared to both the virtual reality and control groups (p < .05).

CONCLUSIONS

Using kaleidoscope during vaccination in 48-month-old children effectively reduced pain, fear, and anxiety. Integrating kaleidoscope as a distraction method during routine vaccination procedures may enhance the vaccination experience and potentially improve adherence to vaccination schedules.

REGISTRATION

Clinical trials number is NCT0611XXXX.

Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis

BACKGROUND

Effective pain control is crucial to optimise the success of medical procedures. Immersive virtual reality (VR) technology could offer an effective non-invasive, non-pharmacological option to distract patients and reduce their experience of pain. We aimed to evaluate the efficacy of Immersive virtual reality (VR) technology in reducing patient's pain perception during various medical procedures by conducting a systematic review and meta-analysis.

METHODS

We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and SIGLE until December 2022 for all randomised clinical trials (RCT) evaluating any type of VR in patients undergoing any medical procedure. We conducted a random effect meta-analysis summarising standardised mean differences (SMD) with 95% confidence intervals (CI). We evaluated heterogeneity using I 2 and explored it using subgroup and meta-regression analyses.

RESULTS

In total, we included 92 RCTs (n = 7133 participants). There was a significant reduction in pain scores with VR across all medical procedures (n = 83, SMD - 0.78, 95% CI - 1.00 to - 0.57, I 2 = 93%, p = < 0.01). Subgroup analysis showed varied reduction in pain scores across trial designs [crossover (n = 13, SMD - 0.86, 95% CI - 1.23 to - 0.49, I 2 = 72%, p = < 0.01) vs parallel RCTs (n = 70, SMD - 0.77, 95% CI - 1.01 to - 0.52, I 2 = 90%, p = < 0.01)]; participant age groups [paediatric (n = 43, SMD - 0.91, 95% CI - 1.26 to - 0.56, I 2 = 87%, p = < 0.01) vs adults (n = 40, SMD - 0.66, 95% CI - 0.94 to - 0.39, I 2 = 89%, p = < 0.01)] or procedures [venepuncture (n = 32, SMD - 0.99, 95% CI - 1.52 to - 0.46, I 2 = 90%, p = < 0.01) vs childbirth (n = 7, SMD - 0.99, 95% CI - 1.59 to - 0.38, I 2 = 88%, p = < 0.01) vs minimally invasive medical procedures (n = 25, SMD - 0.51, 95% CI - 0.79 to - 0.23, I 2 = 85%, p = < 0.01) vs dressing changes in burn patients (n = 19, SMD - 0.8, 95% CI - 1.16 to - 0.45, I 2 = 87%, p = < 0.01)]. We explored heterogeneity using meta-regression which showed no significant impact of different covariates including crossover trials (p = 0.53), minimally invasive procedures (p = 0.37), and among paediatric participants (p = 0.27). Cumulative meta-analysis showed no change in overall effect estimates with the additional RCTs since 2018.

CONCLUSIONS

Immersive VR technology offers effective pain control across various medical procedures, albeit statistical heterogeneity. Further research is needed to inform the safe adoption of this technology across different medical disciplines.

Comparing novel virtual reality and nursing standard care on burn wound care pain in adolescents: A randomized controlled trial

PURPOSE

This study compared the effectiveness of age-appropriate, high technology, interactive virtual reality (VR) distraction with standard care (SC) provided by the nurse on adolescents' acute procedural pain intensity perception during burn wound care treatment in the ambulatory clinic setting.

DESIGN

This randomized controlled trial included 43 adolescents ages 10-21 from the ambulatory burn clinic of a large children's hospital.

METHODS

Blinded study participants were randomly assigned to either VR or SC (non-significantly different, current mean burn surface area, 1.3 and 1.7, respectively) during the first burn wound care procedure in the burn clinic. Blinded research staff collected pre-procedure data including Spielberger's State-Trait Anxiety Inventory and postprocedure wound care pain intensity using the Adolescent Pediatric Pain Tool. A total of 41 participants completed all study procedures.

RESULTS

No statistically significant difference in burn wound care procedural pain was noted between the VR and SC groups after adjusting for several factors. Pre-procedure state and trait anxiety correlated with reported pre-procedure pain. Wound care pain was found to be significantly associated with pre-wound care pain score, time from original burn to clinic burn care treatment, and length of wound care treatment. These factors accounted for approximately 45% of the variation in pain scores during wound care treatment.

PRACTICE IMPLICATIONS

VR distraction can be a useful pain management strategy but may not take the place of the unique nurse-patient relationship that occurs during clinical encounters. Tailoring pain management during burn wound care requires consideration of anxiety, time from the burn injury to the wound care procedure, length of time of the wound care procedure, and pretreatment pain level. Knowing patients' needs, desires, and temperaments along with the specifics about the healthcare procedures are critical to formulating individualized care plans that may or may not include VR. Newer technology, such as easier-to-use, less expensive VR, may assist with translation into practice making its clinical use more routine.

Virtual reality vs. buzzy®. efficacy in pain and anxiety management during pediatric venipuncture. Systematic review and meta-analysis

PROBLEM

Non-pharmacological distraction methods are novel alternatives that can help to alleviate pain and anxiety generated by venipuncture in the pediatric population. The aim is to determine the effectiveness of virtual reality, compared to cold and vibration devices (Buzzy® device), as a distraction method used during venipuncture in the management of pain and anxiety in children.

ELIGIBILITY CRITERIA

Clinical trials, cohort and quasi-experimental studies, published between 2017 and 2022, in Spanish or English and pediatric age, found in Medline, the Cochrane Library, Scopus, Web Of Science, CINAHL and Embase databases.

SAMPLE

Twenty-one studies were included and ten met the criteria for meta-analysis.

RESULTS

Fifty-seven percent of the studies evaluate virtual reality, 33.3% the Buzzy® device and 9.5% both comparatively. The effectiveness of virtual reality in reducing pain (66.6%, n = 14) and anxiety (47.6%, n = 10) compared to standard care (control group), 95% CI = 1.53 [0.91-2.16], p < 0.001, I2 = 78% and 95% CI = 1.53 [1.16-1.90]), p < 0.001, I2 = 77% respectively is demonstrated. Similarly, the effectiveness of Buzzy® in reducing pain (42.9%, n = 9) and anxiety (23.8%, n = 5), 95% CI = 1.62 [0.90-2.34], p < 0.001, I2 = 94% and 95% CI = 1.40 [0.06-2.20, p < 0.001, I2 = 91% respectively is demonstrated. Comparatively, there is no significant difference between both methods 95% CI = 0.29 [-0.19-0.78], p = 0.24, I2 = 81%.

CONCLUSIONS

The methods studied are effective in relieving pain and anxiety during venipuncture. Further research is needed on the level of satisfaction, adverse effects and cost-benefit.

IMPLICATIONS

This study provides evidence of novel tools in daily practice to provide more humane, holistic and quality care.

Sensory stimulations potentializing digital therapeutics pain control

For the past two decades, using Digital Therapeutics (DTx) to counter painful symptoms has emerged as a novel pain relief strategy. Several studies report that DTx significantly diminish pain while compensating for the limitations of pharmacological analgesics (e.g., addiction, side effects). Virtual reality (VR) is a major component of the most effective DTx for pain reduction. Notably, various stimuli (e.g., auditory, visual) appear to be frequently associated with VR in DTx. This review aims to compare the hypoalgesic power of specific stimuli with or without a VR environment. First, this review will briefly describe VR technology and known elements related to its hypoalgesic effect. Second, it will non-exhaustively list various stimuli known to have a hypoalgesic effect on pain independent of the immersive environment. Finally, this review will focus on studies that investigate a possible potentialized effect on pain reduction of these stimuli in a VR environment.

The Effect of Virtual Reality on Pain Experienced by School-Age Children During Venipuncture: A Randomized Controlled Study

Objective: The use of virtual reality (VR) as a non-pharmacologic method may enable children to tolerate invasive procedures in a hospital setting easily and feel less pain. This study aimed at determining the effect of using a VR headset during venipuncture on pain level, heart rate (HR), and oxygen saturation values in children aged 7-12 years old. Materials and Methods: This was a randomized controlled experimental study. This study included 102 children (experimental group: 52; control group: 50) who visited a pediatric outpatient clinic of a university hospital in Turkey between May 2018 and May 2019. Data were collected using the Child and Family Information Form, State Anxiety Inventory for Children, Faces Pain Scale-Revised (FPS-R). Before venipuncture, state anxiety and pain scores of the children were evaluated. The children in the experimental group wore VR headsets during venipuncture. The children in the control group underwent standard venipuncture procedure. Pain scores were evaluated again in both groups after the venipuncture. Before, during, and after the venipuncture, pulse and oxygen saturation values were measured. Results: It was determined that post-procedure pain score was 1.46 ± 1.49 in the experimental group and 4.44 ± 2.26 in the control group. Post-venipuncture pain mean scores were significantly lower in the experimental group than those of the children in the control group (Z = -6.574; P = 0.001). Secondary outcomes: The mean HR during the procedure was significantly lower in the experimental group (99.27 ± 18.34/min) than in the control group (108.20 ± 21.42/min) (P = 0.026; t = -2.265). There was no statistically significant difference between the before and after the procedure difference of oxygen saturation values (Experimental group: -0.15 ± 1.54; Control Group: 0.04 ± 0.93) between groups (Z = -0.023; P = 0.982). Conclusion: It was determined that post-venipuncture pain mean scores were significantly lower in the experimental group than in the control group. VR is effective to reduce the pain of children during venipuncture. VR headsets may be recognized as effective instruments to reduce the pain level of children in hospital settings. (Clinicaltrials.gov: NCT04950478).

The Emerging Role of Virtual Reality as an Adjunct to Procedural Sedation and Anesthesia: A Narrative Review

Over the past 20 years, there has been a significant reduction in the incidence of adverse events associated with sedation outside of the operating room. Non-pharmacologic techniques are increasingly being used as peri-operative adjuncts to facilitate and promote anxiolysis, analgesia and sedation, and to reduce adverse events. This narrative review will briefly explore the emerging role of immersive reality in the peri-procedural care of surgical patients. Immersive virtual reality (VR) is intended to distract patients with the illusion of "being present" inside the computer-generated world, drawing attention away from their anxiety, pain, and discomfort. VR has been described for a variety of procedures that include colonoscopies, venipuncture, dental procedures, and burn wound care. As VR technology develops and the production costs decrease, the role and application of VR in clinical practice will expand. It is important for medical professionals to understand that VR is now available for prime-time use and to be aware of the growing body in the literature that supports VR.

A Systematic Review of Randomized Controlled Trials on Virtual Reality Application in Pediatric Patients

Virtual reality is a novel approach for distracting and alleviating anxiety, pain, and other complications during medical procedures, and it can be more effective than conventional methods. In virtual reality, the patient is completely immersed in the virtual environment, which is used to make patients feel more comfortable and can provide a positive prognosis. The data were searched by using the Boolean operator "AND" between the search phrases "Virtual reality," and "Pediatrics" and the relevant literature was extracted. The inclusion criteria were the free full text, randomized controlled trials, studies between 2016 and 2022 and pediatric patients. This systematic review was conducted to compare randomized controlled trials of virtual reality applications in pediatric patients in different clinical settings. Of the included 15 randomized controlled trials, 12 studies were on pain and anxiety, two on brain injury and cerebral palsy, and one on awareness among asthmatic patients. This review concluded that virtual reality exposure has a beneficial effect on pediatric patients in reducing pain and anxiety, improving muscle strength and dexterity, and awareness among asthmatic patients.

Distraction With Virtual Reality Goggles in Paediatric Dental Treatment: A Randomised Controlled Trial

AIM

The aim of this study was to examine whether screening content through virtual reality (VR) goggles can diminish pain perception during local anaesthesia administered using the inferior alveolar nerve block technique and rubber dam placement in routine paediatric dental treatment.

MATERIALS AND METHODS

This is a crossover study of healthy 4- to 12-year-old children who were scheduled to receive local anaesthesia administered using the inferior alveolar nerve block technique and rubber dam placement in 2 visits. The participants were randomly assigned to undergo 1 treatment performed with Oculus GO VR goggles and the other treatment without. Pain was evaluated using the Wong-Baker FACES Pain Rating Scale and the Modified Behavioral Pain Scale (MBPS).

RESULTS

The study group included 29 children with a mean age of 8.29 years (SD, 1.96). Whilst administering local anaesthesia, no significant difference was observed in the Wong-Baker FACES Pain Rating Scale and in MBPS movements between visits with and without the VR goggles. However, significantly lower pain perception was observed in the other parameters of MBPS when using the VR goggles: Face (P = .007) and Cry (P = .046). During placement of a rubber dam, significantly less pain was reported by the patients (P = .005) and observed by the assessor (Face [P = .005], Cry [P = .029], and Movement [P = 0.028]) when the VR goggles were used.

CONCLUSIONS

VR can decrease pain perception during rubber dam placement in children, but it has limited benefit during administration of local anaesthesia.