虚拟现实与对照和非沉浸式对照相比，可提高儿童的压痛阈和降低焦虑-一项随机交叉试验。

Virtual reality increases pressure pain threshold and lowers anxiety in children compared with control and non-immersive control-A randomized, crossover trial.

机构信息

Department of Children's Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark.

Danish Paediatric Orthopaedic Research; Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark.

出版信息

Eur J Pain. 2023 Aug;27(7):805-815. doi: 10.1002/ejp.2108. Epub 2023 Mar 21.

DOI:10.1002/ejp.2108

PMID:36897663

Abstract

BACKGROUND

Virtual reality (VR) is a promising non-pharmacological pain intervention because it may not only distract but also modulate pain by immersing the user in a three-dimensional 360° alternate reality. In children, VR has been reported to reduce clinical pain and anxiety during medical procedures. However, the effect of immersive VR on pain and anxiety remains to be investigated in randomized controlled trials (RCT). The aim of the present crossover RCT was to assess the effect of VR on pressure pain threshold (PPT) and anxiety level measured with the modified Yale Preoperative Anxiety Scale (mYPAS) in children in a controlled experimental setting.

METHODS

Seventy-two children (mean age 10.2 (6-14) years) were randomized to 24 sequences of four interventions (immersive VR Game, immersive VR video, tablet: 2D video and control: small talk). Outcome measures PPT, mYPAS and heart rate were assessed before and after each intervention.

RESULTS

PPT increased significantly during VR game (PPTdiff): 136 kPa (CI 112; 161), p < 0.0001 and VR Video (PPTdiff): 122 kPa (CI 91; 153), p < 0.0001. Also, anxiety levels significantly decreased during both VR game (mYPASdiff: -7 points (-8 to -5), p < 0.0001) and VR video (mYPASdiff: -6 points (CI -7; -4), p < 0.0001).

CONCLUSIONS

VR had a marked beneficial effect on PPT and anxiety compared with the control interventions: 2D video and small talk. Thus, immersive VR had a distinct modulatory effect on pain and anxiety in a well-controlled experimental setting. Immersive VR was effective and feasible in children and can act as a valid tool for non-pharmacological pain and anxiety management.

SIGNIFICANCE

Paediatric immersive VR seems to be beneficial although well-controlled studies are pending. We investigated whether immersive VR can modulate children's threshold for pain and anxiety level in an experimental well-controlled setting. We document a modulatory pain threshold increase and anxiety level decrease compared with extensive control conditions. Paediatric immersive VR is effective, feasible and valid for non-pharmacological pain and anxiety management. All efforts to reach the goal that no child should experience pain or anxiety when exposed to medical procedures.

摘要

背景

虚拟现实（VR）是一种很有前途的非药物性疼痛干预手段，因为它不仅可以分散注意力，还可以通过将使用者沉浸在三维 360°的替代现实中来调节疼痛。在儿童中，已经有报道称 VR 可以减少医疗过程中的临床疼痛和焦虑。然而，沉浸式 VR 对疼痛和焦虑的影响仍需要在随机对照试验（RCT）中进行研究。本交叉 RCT 的目的是在受控实验环境中评估 VR 对压力疼痛阈值（PPT）和使用改良耶鲁术前焦虑量表（mYPAS）测量的焦虑水平的影响。

方法

72 名儿童（平均年龄 10.2（6-14）岁）被随机分为 24 个四组干预序列（沉浸式 VR 游戏、沉浸式 VR 视频、平板电脑：2D 视频和对照组：闲聊）。在每次干预前后评估 PPT、mYPAS 和心率。

结果

在 VR 游戏（PPTdiff）中，PPT 显著增加：136kPa（CI 112；161），p<0.0001，在 VR 视频（PPTdiff）中，PPT 显著增加：122kPa（CI 91；153），p<0.0001。此外，在 VR 游戏（mYPASdiff：-7 分（-8 至-5），p<0.0001）和 VR 视频（mYPASdiff：-6 分（CI -7；-4），p<0.0001）中，焦虑水平也显著降低。

结论

与对照组干预措施（2D 视频和闲聊）相比，VR 对 PPT 和焦虑有明显的有益影响。因此，在受控的实验环境中，沉浸式 VR 对疼痛和焦虑具有明显的调节作用。沉浸式 VR 在儿童中是有效和可行的，可以作为非药物性疼痛和焦虑管理的有效工具。

意义

尽管还需要进行更多的对照研究，但儿科沉浸式 VR 似乎是有益的。我们调查了沉浸式 VR 是否可以在实验性受控环境中调节儿童的疼痛阈值和焦虑水平。与广泛的对照条件相比，我们记录了疼痛阈值的增加和焦虑水平的降低。儿科沉浸式 VR 是一种有效的、可行的、有效的非药物性疼痛和焦虑管理工具。我们将尽一切努力，使每一个孩子在接受医疗程序时都不会感到疼痛或焦虑。