Podcast: What are the benefits and risks of using virtual reality in a healthcare setting to distract children from pain?

The Cochrane Pain, Palliative and Supportive Care Group has more than 250 active reviews of the effects of a wide range of interventions. These were added to in October 2020 by a new review of the effects of using virtual reality to distract children undergoing painful procedures. We asked lead author, Veronica Lambert from Dublin City University in Ireland to tell us that they found.

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Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. The Cochrane Pain, Palliative and Supportive Care Group has more than 250 active reviews of the effects of a wide range of interventions. These were added to in October 2020 by a new review of the effects of using virtual reality to distract children undergoing painful procedures. We asked lead author, Veronica Lambert from Dublin City University in Ireland to tell us that they found.

Veronica: Children attending healthcare settings sometimes need treatments and other procedures that might be painful, and it's common practice to try to distract them with toys or play in the hope that this will minimise their distress or fear of pain. One distraction method that might be used is virtual reality, which is a computer technology that creates an artificial environment with scenes and objects that appear to be similar to the real world. It's thought to alter pain perception by directing the user's attention away from unwanted sensations, as well as changing the way that incoming pain signals are interpreted. However, the effects are uncertain and we wanted to investigate the potential benefits of virtual reality for distracting children from acute pain, and whether there were any associated unwanted effects.
Our primary outcome was acute pain intensity measured using self-report, observer-report and behavioural measurement, and assessed during the procedure and up to one hour after it. We had also hoped to look at adverse effects related to virtual reality, children's satisfaction with virtual reality and their pain-related distress, parent anxiety, use of additional pain relief beyond the child's scheduled regimen, so-called rescue analgesia, and cost; but there was limited data and inconsistent evidence for these outcomes, and no studies assessed parent anxiety or cost.
In total, we found 17 randomised trials involving just over 1000 children aged from four to 18 years. They were undergoing a variety of treatments and procedures, including intravenous puncture, changes of wound dressings and physical therapy sessions. Some studies compared virtual reality to no distraction and some compared it to other types of distraction, but there were no studies directly comparing different types of virtual reality distraction grouped, for example, by level of immersion which is one of the ways to categorise virtual reality interventions.
Overall, this collection of research provides only low to very low certainty evidence, which makes it difficult to identify the benefits, or lack of benefits, of virtual reality distraction for acute pain in children in any healthcare setting. Many of the outcomes we were most interested in were assessed by only two or three small studies, and we were unable to pool the results in meta-analyses because of variations in important aspects, such as the child's age, the procedure or treatment. 
In summary, therefore, it remains unclear from our review whether virtual reality distraction makes a difference to acute pain intensity in children. More evidence is needed before virtual reality distraction could be considered as a technique for reducing acute pain in children. This will need to come from high-quality randomised trials with larger sample sizes and it would also be helpful if future paediatric trials used standardized age groups to enhance consistency in their age-related data and improve the potential for data pooling, the exploration of variation across age groups and recommendations tailored to specific age groups. Future trials also need to establish the effectiveness of virtual reality for a variety of clinical experiences with different pain intensities and distress levels.

Monaz: If you would like to read the current version of the review and watch for future updates should those new studies become available, you can find the review at Cochrane Library dot com with a search for 'virtual reality distraction for acute pain'.

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