Center for Understanding Pediatric Pain, Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
J Med Internet Res. 2021 Jul 12;23(7):e26328. doi: 10.2196/26328.
Distraction-based therapies, such as virtual reality (VR), have been used to reduce pain during acutely painful procedures. However, distraction alone cannot produce prolonged pain reduction to manage sustained postoperative pain. Therefore, the integration of VR with other pain-reducing therapies, like guided relaxation, may enhance its clinical impact.
The goal of this pilot study was to assess the impact of a single guided relaxation-based VR (VR-GR) session on postoperative pain and anxiety reduction in children. We also explored the influence of pain catastrophizing and anxiety sensitivity on this association.
A total of 51 children and adolescents (7-21 years) with postoperative pain and followed by the Acute Pain Service at Cincinnati Children's Hospital were recruited over an 8-month period to undergo a single VR-GR session. Prior to VR, the patients completed 2 questionnaires: Pain Catastrophizing Scale for Children (PCS-C) and the Child Anxiety Sensitivity Index (CASI). The primary outcome was a change in pain intensity following the VR-GR session (immediately, 15 minutes, and 30 minutes). The secondary outcomes included changes in pain unpleasantness and anxiety.
The VR-GR decreased pain intensity immediately (P<.001) and at 30 minutes (P=.04) after the VR session, but not at 15 minutes (P=.16) postsession. Reductions in pain unpleasantness were observed at all time intervals (P<.001 at all intervals). Anxiety was reduced immediately (P=.02) but not at 15 minutes (P=.08) or 30 minutes (P=.30) following VR-GR. Patients with higher CASI scores reported greater reductions in pain intensity (P=.04) and unpleasantness (P=.01) following VR-GR. Pain catastrophizing was not associated with changes in pain and anxiety.
A single, short VR-GR session showed transient reductions in pain intensity, pain unpleasantness, and anxiety in children and adolescents with acute postoperative pain. The results call for a future randomized controlled trial to assess the efficacy of VR-GR.
ClinicalTrials.gov NCT04556747; https://clinicaltrials.gov/ct2/show/NCT04556747.
分散注意力疗法，如虚拟现实（VR），已被用于减轻急性疼痛过程中的疼痛。然而，单纯的分散注意力并不能持续减轻疼痛，以控制术后持续疼痛。因此，将 VR 与其他减轻疼痛的疗法（如引导放松）结合使用，可能会增强其临床效果。
本初步研究的目的是评估单次基于引导放松的 VR（VR-GR）治疗对儿童术后疼痛和焦虑减轻的影响。我们还探讨了疼痛灾难化和焦虑敏感性对这种关联的影响。
在 8 个月的时间里，共有 51 名在辛辛那提儿童医院接受急性疼痛服务的术后疼痛儿童和青少年患者被招募来接受单次 VR-GR 治疗。在进行 VR 之前，患者完成了 2 份问卷：儿童疼痛灾难化量表（PCS-C）和儿童焦虑敏感性指数（CASI）。主要结局是 VR-GR 治疗后疼痛强度的变化（即刻、15 分钟和 30 分钟）。次要结局包括疼痛不适和焦虑的变化。
VR-GR 治疗即刻（P<.001）和 30 分钟（P=.04）后疼痛强度降低，但 15 分钟（P=.16）后无明显降低。所有时间间隔的疼痛不适均有减轻（所有间隔均为 P<.001）。焦虑即刻减轻（P=.02），但 15 分钟（P=.08）或 30 分钟（P=.30）后无明显减轻。CASI 评分较高的患者报告 VR-GR 后疼痛强度（P=.04）和疼痛不适（P=.01）的降低更明显。疼痛灾难化与疼痛和焦虑的变化无关。
单次短时间 VR-GR 治疗可使急性术后疼痛的儿童和青少年的疼痛强度、疼痛不适和焦虑得到短暂减轻。结果呼吁进行未来的随机对照试验来评估 VR-GR 的疗效。
ClinicalTrials.gov NCT04556747；https://clinicaltrials.gov/ct2/show/NCT04556747。
