The Association Between Pain Relief Using Video Games and an Increase in Vagal Tone in Children With Cancer: Analytic Observational Study With a Quasi-Experimental Pre/Posttest Methodology

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>Patients with secondary pain due to mucositis after chemotherapy require treatment with morphine. Use of electronic video games (EVGs) has been shown to be an effective method of analgesia in other clinical settings.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>The main objective of this study was to assess the association between the use of EVGs and the intensity of pain caused by chemotherapy-induced mucositis in pediatric patients with cancer. The secondary objective was to assess the association between changes in pain intensity and sympathetic-parasympathetic balance in this sample of pediatric patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Clinical records were compared between the day prior to the use of EVGs and the day after the use of EVGs. The variables were variations in pupil size measured using the AlgiScan video pupilometer (IDMed, Marseille, France), heart rate variability measured using the Analgesia Nociception Index (ANI) monitor (Mdoloris Medical Systems, Loos, France), intensity of pain measured using the Numerical Rating Scale (score 0-10), and self-administered morphine pump parameters.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Twenty patients (11 girls and nine boys; mean age 11.5 years, SD 4.5 years; mean weight 41.5 kg, SD 20.7 kg) who met all the inclusion criteria were recruited. EVGs were played for a mean of 2.3 (SD 1.3) hours per day, resulting in statistically significant changes. After playing EVGs, there was significantly lower daily morphine use (before vs after playing EVGs: 35.9 vs 28.6 µg/kg/day, P=.003), lower demand for additional pain relief medication (17 vs 9.6 boluses in 24 hours, P=.001), lower scores of incidental pain intensity (7.7 vs 5.4, P=.001), lower scores of resting pain (4.8 vs 3.2, P=.01), and higher basal parasympathetic tone as measured using the ANI monitor (61.8 vs 71.9, P=.009). No variation in pupil size was observed with the use of EVGs.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The use of EVGs in pediatric patients with chemotherapy-induced mucositis has a considerable analgesic effect, which is associated physiologically with an increase in parasympathetic vagal tone despite lower consumption of morphine.</jats:p> </jats:sec>

Intravenous opioids for chemotherapy‐induced severe mucositis pain in children: Systematic review and single‐center case series of management with patient‐ or nurse‐controlled analgesia (PCA/NCA)

“…Excluded studies encompassed: reviews without original data, 31,32 single case reports, 33 data for degree and/or duration of IV opioid was not included, or the proportion of children requiring IV opioid analgesia was reported without specific details of the duration or dose, 34‐38 or opioid was administered by an alternative route (eg, intranasal 39 or topical 40 ; Figure 1). Seventeen articles (six RCTs, two prospective observational studies, three retrospective cohort studies, six retrospective case series) fulfilled inclusion criteria and reported the duration and/or dose of IV opioid in children with severe mucositis following chemotherapy for tumor management or HSCT 21‐23,41‐54 …”

“…Three randomized trials compared dose requirements for different IV opioids 43,50 or delivery methods 49 . Three randomized trials 47,48,52 and one prospective observational study 41 reported opioid requirement as an outcome for efficacy of mucositis interventions.…”

“…Parameters for reporting patient age varied. Ages ranged from 0.3 to 22.3 years in 11/17 studies 21,23,44‐51 ; mean/median from 3.4 to 15.3 years 22,23,41‐45,47‐49,51,54,50,21 ; with a combined weighted mean of 10.9 years 21‐23,41,42,44,45,47‐51,54 . The proportion of males ranged from 45 to 64% in 14/17 studies (total 325/576; Table 1).…”

“…Reporting and details of underlying diagnoses varied across studies, and while one study compared different chemotherapy regimens in patients with neuroblastoma, 45 the remaining 16 studies included patients with a number of different hematological 41,43,48 and/or solid tumors 22,23,47,51‐54 . Chemotherapy indications included cancer therapy 21,22,41,48,50,52,54 and/or preconditioning for HSCT (approximately 63%); for the latter the majority were for malignancy, 23,41‐47,49,51,53 with a smaller proportion (<10%) for nonmalignant (eg, aplastic anemia, metabolic disorders 21,23,42,44,47,51 ) conditions (Table 1).…”

The Role of Enjoyment in a Serious Game for Binge Drinking Prevention: Pretest-Posttest Quasi-Experimental Study

“…This study utilized a one-group pretest-posttest quasi-experimental design [40], which has been used to evaluate serious video games for alcohol prevention [13], as well as other health education topics [41,42]. The One Shot video game was implemented online and made accessible to study participants.…”