Virtual restorative environment therapy as an adjunct to pain control during burn dressing changes: study protocol for a randomised controlled trial

Abstract

BackgroundThe pain of a severe burn injury is often characterised by intense background pain, coupled with severe exacerbations associated with essential procedures such as dressing changes. The experience of pain is affected by patients’ psychological state and can be enhanced by the anxiety, fear and distress caused by environmental and visual inputs. Virtual Reality (VR) distraction has been used with success in areas such as burns, paediatrics and oncology. The underlying principle of VR is that attention is diverted from the painful stimulus by the use of engaging, dynamic 3D visual content and associated auditory stimuli. Functional magnetic resonance imaging (fMRI) studies undertaken during VR distraction from experimental pain have demonstrated enhancement of the descending cortical pain-control system.Methods/DesignThe present study will evaluate the feasibility of introducing a novel VR system to the Burns Unit at the Queen Elizabeth Hospital Birmingham for dressing changes: virtual restorative environment therapy (VRET). The study will also explore the system’s impact on pain during and after the dressing changes compared to conventional analgesia for ward-based burn dressing changes. A within-subject crossover design will be used to compare the following three conditions:Interactive VRET plus conventional analgesics.Passive VRET with conventional analgesics.Conventional analgesics alone.Using the Monte Carlo method, and on the basis of previous local audit data, a sample size of 25 will detect a clinically significant 33 % reduction in worst pain scores experienced during dressing changes.DiscussionThe study accrual rate is currently slower than predicted by previous audits of admission data. A review of the screening log has found that recruitment has been limited by the nature of burn care, the ability of burn inpatients to provide informed consent and the ability of patients to use the VR equipment. Prior to the introduction of novel interactive technologies for patient use, the characteristics and capabilities of the target population needs to be evaluated, to ensure that the interface devices and simulations are usable.Trial registrationCurrent Controlled Trials ISRCTN23330756. Date of Registration 25 February 2014.

Enhanced Reality Showing Long-Lasting Analgesia after Total Knee Arthroplasty: Prospective, Randomized Clinical Trial

“…Two systemic reviews concluded that VR has the potential to be an useful analgesic tool, but more evidence is required 36 , 37 . With no randomized controlled trials except a single on-going trial 5 , it is important to check the long-lasting effect. In comparison within the group, the FTI group showed a significant improvement which was maintained at 3 weeks after discontinuation of the intervention; however, the improvement in HTI group lasted only one week.…”

“…However, all previous publications were case reports, case series, or pilot trials, except a single on-going randomized control trial by Small et al . 5 . Moreover, these investigations evaluated only the short-term analgesic effect and there are no reports about the long-term effects.…”

What is the best way of delivering virtual nature for improving mood? An experimental comparison of high definition TV, 360° video, and computer generated virtual reality

“…Computer Generated or CG-VR, e.g. ( Small, Stone, Pilsbury, Bowden, & Bion, 2015 ). Both approaches use a HMD with a head tracking system to generate instantaneous co-ordination of the user's head movements between the physical and virtual worlds ( Slater & Sanchez-Vives, 2016 ).…”

Virtual reality, music, and pain: developing the premise for an interdisciplinary approach to pain management

“…Virtual reality pain management for acute pain has been frequently studied and reviewed in both healthy subjects 11,25,80,81 and pain patients, especially burn victims 26,37,44,53,75,79 and patients with phantom limb pain. 1,68,73 One pioneering study was conducted on 2 adolescents, showing that they were able to better tolerate painful procedures during burn dressing changes during a VR experience.…”