Summary: Virtual reality helps to relieve pain and anxiety for children undergoing medical procedures, researchers report.
Source: Children’s Hospital Los Angeles
It isn’t a matter of one needle puncture. Many children coming through the doors of Children’s Hospital Los Angeles are seen for chronic conditions and often require frequent visits. Painful procedures—like a blood draw or catheter placement—can cause anxiety and fear in patients.
Now, a study published in JAMA Network Open shows that virtual reality can decrease pain and anxiety in children undergoing intravenous (IV) catheter placement.
For nearly two decades, Jeffrey I. Gold, Ph.D., an investigator at The Saban Research Institute of Children’s Hospital Los Angeles, has been investigating the use of virtual reality (VR) as a technique to help children undergoing painful medical procedures. His research shows that the technology can have powerful effects. VR works so well that Children’s Hospital Los Angeles now offers it routinely for blood draws.
“Some patients don’t even realize that their blood is being drawn,” says Dr. Gold, who is also a Professor of Clinical Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences at The Keck School of Medicine of USC. “Compare that to a child who is panicking and screaming, and it’s a no-brainer. We want kids to feel safe.”
In his recent publication, Dr. Gold’s team reports the results of a study to test whether VR could prevent pain and distress for patients undergoing peripheral intravenous catheter (PIVC) placement. The game is simple, but requires focus and participation. Patients in one group used VR throughout the procedure, while those in another group received standard of care, which includes simple distraction techniques and the use of a numbing cream. The patients who used VR reported significantly lower levels of pain and anxiety.
“We can actually reduce pain without the use of a medication,” says Dr. Gold. “The mind is incredibly powerful at shifting focus and actually preventing pain from being registered. If we can tap into that, we can make the experience much better for our kids.”
But the story is bigger than that.
This is one of the first studies to analyze the effects of VR not only from the patient perspective, but also from that of the clinician and the patient’s family or caregivers. All three of these groups reported a more positive experience with the use of VR. Dr. Gold calls this triangulation of data—gathering information from three perspectives in order to improve patient experience.
“We started this as a way to mitigate pain and overall distress in children. But caregivers and healthcare providers are also reporting improved outcomes,” adds Dr. Gold, “effectively treating the patient clearly has a ripple effect.”
Consider a typical scenario in which a child has a chronic illness and must routinely receive PIVC placement. A patient experiencing anxiety about her procedure may tense up, making it more difficult for the clinician to find a vein and insert the catheter. If multiple attempts are necessary, a child’s fear may amplify, causing a snowball effect, which in turn may impact medical adherence and ultimately long-term health outcomes.
If, on the other hand, the patient plays a virtual game while undergoing the procedure, she may relax and experience less pain, improving the overall experience for the child, the family, and the healthcare provider.
“Stress actually causes veins to constrict,” says Dr. Gold, “but you don’t need to know the physiology to know that it’s better to have a relaxed kid.”
The ripple effect goes further. A child’s experience during a visit sets the tone for future visits. If the experience feels traumatic, the child and family may be less likely to adhere with scheduled visits or may feel more stressed coming back to the hospital. “We don’t want a child’s healthcare experience to be another adverse childhood experience,” says Gold. Adverse childhood experiences, also called ACEs, can lead to poor health outcomes.
“We care about the healthcare experience that children have,” says Dr. Gold. “By reducing fear associated with routine procedures, we prepare the child to begin treatment with a more positive outlook, and this can affect their health for a lifetime.”
Effect of an Immersive Virtual Reality Intervention on Pain and Anxiety Associated With Peripheral Intravenous Catheter Placement in the Pediatric Setting
The inclusion of digital therapeutics (eg, virtual reality [VR] systems) for the management of pain and anxiety associated with routine acutely painful medical procedures may have a substantial impact on treatment adherence and improve long-term health outcomes among young patients.
To determine whether a VR intervention decreases pain and anxiety among patients undergoing peripheral intravenous catheter (PIVC) placement compared with standard care in the pediatric setting.
This randomized clinical trial was conducted from April 12, 2017, to July 24, 2019, among 107 patients aged 10 to 21 years who were undergoing PIVC placement in 2 clinical settings (a radiology department and an infusion center) at an urban pediatric academic medical center in the US. Patients, caregivers, and clinicians completed pre-PIVC and post-PIVC placement questionnaires measuring patient pain, anxiety, and anxiety sensitivity; only participants with complete data from before and after PIVC placment were included in the analyses.
Patients were randomized to receive standard care (simple distraction techniques [eg, music, coloring, singing, and talking] and the application of numbing cream) or a VR intervention using a balanced computer-generated randomization scheme stratified by sex. All patients who received the VR intervention were offered concurrent standard care; however, VR plus standard care was not specifically examined.
Main Outcomes and Measures
Primary outcomes were patient pain (measured by the Faces Pain Scale–Revised) and anxiety (measured by a visual analogue scale) reported by the patient, caregiver, and clinician after PIVC placement. Outcomes were analyzed using generalized linear modeling with backward stepwise selection for final model building.
A total of 107 patients (median age, 14.7 years [interquartile range, 12.8-16.9 years]; 63 male participants [58.9%]) completed the clinical trial; 54 patients received standard care, and 53 patients also received the VR intervention. Patients who received the VR intervention compared with standard care had significantly lower mean post-PIVC anxiety scores when patient-reported (1.85 points [95% CI, 1.28-2.41 points] vs 3.14 points [95% CI, 2.59-3.68 points]; P < .001) and clinician-reported (2.04 points [95% CI, 1.37-2.71 points] vs 3.34 points [95% CI, 2.69-3.99 points]; P = .002). Patients in the VR group vs the standard care group also had significantly lower mean post-PIVC pain scores when patient-reported (1.34 points [95% CI, 0.63-2.05 points] vs 2.54 points [95% CI, 1.78-3.30 points]; P = .002), caregiver-reported (1.87 points [95% CI, 0.99-2.76 points] vs 3.01 points [95% CI. 1.98-4.03 points]; P = .04), and clinician-reported (2.05 points [95% CI, 1.47-2.63 points] vs 3.59 points [95% CI, 2.97-4.22 points]; P < .001). Aside from lower levels of baseline pain and anxiety, no demographic variables among patients in the VR group were associated with lower levels of post-PIVC pain and anxiety.
Conclusions and Relevance
In this randomized clinical trial, patients undergoing PIVC placement who received a VR intervention experienced significantly less anxiety and pain compared with those who received standard care. The use of patient, caregiver, and clinician data provided a variety of subjective information, as well as observable and objective data regarding perceived pain and anxiety beyond patient reporting alone.