Features of virtual reality impact effectiveness of VR pain alleviation therapeutics in pediatric burn patients: A randomized clinical trial

Abstract

Key features of virtual reality (VR) that impact the effectiveness of pain reduction remain unknown. We hypothesized that specific features of the VR experience significantly impact VR’s effectiveness in reducing pain during pediatric burn dressing care. Our randomized controlled trial included children 6 to 17 years (inclusive) who were treated in the outpatient clinic of an American Burn Association–verified pediatric burn center. Participants were randomly assigned (1:1:1) to active VR (playing the VR), passive VR (immersed in the same VR environment without interactions), or standard-of-care. On a scale from 0 to 100, participants rated overall pain (primary outcome) and features of the VR experience (game realism, fun, and engagement). Path analysis assessed the interrelationships among these VR key features and their impact on self-reported pain scores. From December 2016 to January 2019, a total of 412 patients were screened for eligibility, and 90 were randomly assigned (31 in the active VR group, 30 in the passive VR group, and 29 in the standard-of-care group). The current study only included those in the VR groups. The difference in median scores of VR features was not statistically significant between the active (realism, 77.5 [IQR: 50–100]; fun, 100 [IQR: 81–100]; engagement, 90 [IQR: 70–100]) and passive (realism, 72 [IQR: 29–99]; fun, 93.5 [IQR: 68–100]; engagement, 95 [IQR: 50–100]) VR distraction types. VR engagement had a significant direct (-0.39) and total (-0.44) effect on self-reported pain score (p<0.05). Key VR features significantly impact its effectiveness in pain reduction. The path model suggested an analgesic mechanism beyond distraction. Differences in VR feature scores partly explain active VR’s more significant analgesic effect than passive VR.

Trial Registration: ClinicalTrials.gov Identifier: NCT04544631.

Author summary

In this randomized controlled trial of 90 pediatric burn patients aged 6–17 years (inclusive) who received burn dressing changes at a pediatric medical center, three key features of virtual reality (VR) (game realism, fun, and engagement) significantly influence self-reported pain scores during burn dressing changes. These findings provide insight into the potential mechanisms through which VR affects pain perception, supporting distraction as a key mechanism of VR analgesia and highlighting a potential neurophysiological mechanism beyond mere distraction. Future studies should employ longitudinal designs, develop objective measures of VR features, develop methods to manipulate VR features, consider clear and specific terminology to describe digital experiences, and further test key features of VR games that could effectively impact the VR pain alleviation therapeutics during a variety of medical procedures.