This study investigated the effectiveness of virtual reality (VR) distraction, compared to comic book distraction and no distraction, in reducing pain and anxiety during a medical procedure in a pediatric population: the skin prick test. Although this test has many advantages and is considered to be minimally invasive, it causes anxiety and painful discomfort in children. Ninety-two children aged 7 to 17 years consulting for an allergic test received VR distraction, comic book distraction, or no distraction. Outcome measures included pain score, level of anxiety, and VR measures. The results showed that there were no significant differences between the three groups regarding sex, age, and preprocedural anxiety level. In the distraction groups (VR and comic book), children reported significantly lower pain and procedural anxiety scores than children with no distraction; VR distraction had a more significant effect than comic book distraction. A decrease in anxiety before and during the skin prick test is significantly more significant in VR distraction. This study suggested the effectiveness and feasibility of VR to reduce pain and anxiety during the pediatric skin prick test.
References
[1]
International Association for the Study of Pain Task Force on Taxonomy (1994) Part III: Pain Terms: A Current List with Definitions and Notes on Usage. In: Merskey, H. and Bogduk, N., Eds., Classification of Chronic Pain, IASP Press, Seattle, 209-214.
[2]
Cummings, E.A., Reid, G.J., Finley, A.G., McGrath, P.J. and Ritchie, J.A. (1996) Prevalence and Source of Pain in Pediatric Inpatients. Pain, 68, 25-31. https://doi.org/10.1016/S0304-3959(96)03163-6
[3]
Lisi, D., Campbell, L., Riddell, R.P., Garfield, H. and Greenberg, S. (2013) Naturalistic Parental Pain Management during Immunizations during the First Year of Life: Observational Norms from the OUCH Cohort. Pain, 154, 1245-1253. https://doi.org/10.1016/j.pain.2013.03.036
[4]
Damen, L., Bruijn, J.K., Verhagen, A.P., Berger, M.Y., Passchier, J. and Koes, B.W. (2005) Symptomatic Treatment of Migraine in Children: A Systematic Review of Medication Trials. Pediatrics, 116, e295-e302. https://doi.org/10.1542/peds.2004-27424
[5]
Silver, S., Gano, D. and Gerretsen, P. (2008) Acute Treatment of Paediatric Migraine: A Meta-Analysis of Efficacy. Journal of Paediatrics and Child Health, 44, 3-9. https://doi.org/10.1111/j.1440-1754.2007.01206.x
[6]
Evers, S. and Marziniak, M. (2010) Clinical Features, Pathophysiology and Treatment of Medication-Overuse Headache. The Lancet Neurology, 9, 391-401. https://doi.org/10.1016/S1474-4422(10)70008-9
[7]
Faber, A.W., Patterson, D.R. and Bremer, M. (2014) Repeated Use of Immersive Virtual Reality Therapy to Control Pain during Wound Dressing Changes in Pediatric and Adult Burn Patients. Journal of Burn Care & Research, 34, 563-568. https://doi.org/10.1097/BCR.0b013e3182777904
[8]
Turk, D.C. (1996) Biopsychosocial Perspective on Chronic Pain. In: Gatchel, R.J. and Turk, D.C., Eds., Psychological Approaches to Pain Management: A Practitioner’s Handbook, The Guilford Press, New York, 3-32.
[9]
Nelson, S., Conroy, C. and Logan, D. (2019) The Biopsychosocial Model of Pain in the Context of Pediatric Burn Injuries. European Journal of Pain, 23, 421-434. https://doi.org/10.1002/ejp.1319
[10]
Leventhal, H., Brown, D., Shacham, S. and Engquist, G. (1979) Effects of Preparatory Information about Sensations, Threat of Pain and Attention on Cold Pressor Distress. Journal of Personality and Social Psychology, 37, 688-714. https://doi.org/10.1037/0022-3514.37.5.688
[11]
Martin, A.L., McGrath, P.A., Brown, S.C. and Katz, J. (2007) Anxiety Sensitivity, Fear of Pain and Pain-Related Disability in Children and Adolescents with Chronic Pain. Pain Research and Management, 12, Article ID: 897395. https://doi.org/10.1155/2007/897395
[12]
Vervoort, T., Eccleston, C., Goubert, L., Buysse, A. and Crombez, G. (2010) Children’s Catastrophic Thinking about Their Pain Predicts Pain and Disability 6 Months Later. European Journal of Pain, 14, 90-96. http://hdl.handle.net/1854/LU-1092621
[13]
Fisher, E., Heathcote, L.C., Eccleston, C., Simons, L.E. and Palermo, T.M. (2018) Assessment of Pain Anxiety, Pain Catastrophizing and Fear of Pain in Children and Adolescents with Chronic Pain: A Systematic Review and Meta-Analysis. Journal of Pediatric Psychology, 43, 314-325. https://doi.org/10.1093/jpepsy/jsx103
[14]
Melzack, R. and Wall, P.D. (1965) Pain Mechanisms: A New Theory. Science, 150, 971-979. https://doi.org/10.1126/science.150.3699.971
[15]
Boerner, K.E., Gillespie, J.M., McLaughlin, E.N., Kuttner, L. and Chambers, C.T. (2014) Implementation of Evidence-Based Psychological Interventions for Pediatric Needle Pain. Clinical Practice in Pediatric Psychology, 2, 224-235. https://doi.org/10.1037/cpp000007415
[16]
de Wied, M. and Verbaten, M.N. (2001) Affective Pictures Processing, Attention and Pain Tolerance. Pain, 90, 163-172. https://doi.org/10.1016/s0304-3959(00)00400-0
[17]
Birnie, K.A., Noel, M., Parker, J.A., Chambers, C.T., Uman, L.S., et al. (2014) Systematic Review and Meta-Analysis of Distraction and Hypnosis for Needle-Related Pain and Distress in Children and Adolescents. Journal of Pediatric Psychology, 39, 783-808. https://doi.org/10.1093/jpepsy/jsu029
[18]
Bukola, I.M. and Paula, D. (2017) The Effectiveness of Distraction as Procedural Pain Management Technique in Pediatric Oncology Patients: A Meta-Analysis and Systematic Review. Journal of Pain and Symptom Management, 54, 589-600.E1. https://doi.org/10.1016/j.jpainsymman.2017.07.006
[19]
Dumoulin, S., Bouchard, S. and Rivard, V. (2007) La Réalité Virtuelle Est-Elle un Moyen Efficace de Gérer la Douleur Aiguë [Is Virtual Reality Effective to Manage Acute Pain]? Revue Québécoise de Psychologie, 28, 65-91. https://psycnet.apa.org/record/2011-08361-004
[20]
Arane, K., Behboudi, A. and Goldman, R.D. (2017) Virtual Reality for Pain and Anxiety Management in Children. Medecin de Famille Canadien/Canadian Family Physician, 63, 932-934. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729140/
[21]
Pratt, D.R., Zyda, M. and Kelleher, K. (1995) Virtual Reality: In the Mind of the Beholder. IEEE Computer, 28, 17-19.
[22]
Eijlers, R., Utens, E., Staals, L. M., de Nijs, P., Berghmans, J.M., et al. (2019) Systematic Review and Meta-analysis of Virtual Reality in Pediatrics: Effects on Pain and Anxiety. Anesthesia and Analgesia, 129, 1344-1353. https://doi.org/10.1213/ANE.0000000000004165
[23]
Kenney, M.P. and Milling, L.S. (2016) The Effectiveness of Virtual Reality Distraction for Reducing Pain: A Meta-Analysis. Psychology of Consciousness: Theory, Research and Practice, 3, 199-210. https://doi.org/10.1037/cns0000084
[24]
Birnie, K.A., Kulandaivelu, Y., Jibb, L., Hroch, P., Positano, K., et al. (2018) Usability Testing of an Interactive Virtual Reality Distraction Intervention to Reduce Procedural Pain in Children and Adolescents with Cancer. Journal of Pediatric Oncology Nursing, 35, 406-416. https://doi.org/10.1177/1043454218782138
[25]
Ng, J., Lo, H., Tong, X., Gromala, D. and Jin, W. (2018) Farmooo, a Virtual Reality Farm Simulation Game Designed for Cancer Pediatric Patients to Distract their Pain during Chemotherapy Treatment. Electronic Imaging, 2018, 432-1-432-4. https://doi.org/10.2352/ISSN.2470-1173.2018.03.ERVR-432
[26]
Jeffs, D., Dorman, D., Brown, S., Files, A., Graves, T., et al. (2014) Effect of Virtual Reality on Adolescent Pain during Burn Wound Care. Journal of Burn Care & Research: Official Publication of the American Burn Association, 35, 395-408. https://doi.org/10.1097/BCR.0000000000000019
[27]
Pardesi, O. and Fuzaylov, G. (2017) Pain Management in Pediatric Burn Patients: Review of Recent Literature and Future Directions. Journal of Burn Care & Research: Official Publication of the American Burn Association, 38, 335-347. https://doi.org/10.1097/BCR.0000000000000470
[28]
Gold, J.I. and Mahrer, N.E. (2018) Is Virtual Reality Ready for Prime Time in the Medical Space? A Randomized Control Trial of Pediatric Virtual Reality for Acute Procedural Pain Management. Journal of Pediatric Psychology, 43, 266-275. https://doi.org/10.1093/jpepsy/jsx129
[29]
Piskorz, J. and Czub, M. (2018) Effectiveness of a Virtual Reality Intervention to Minimize Pediatric Stress and Pain Intensity during Venipuncture. Journal for Specialists in Pediatric Nursing, 23, e12201. https://doi.org/10.1111/jspn.12201
[30]
Goldman, R.D. and Behboudi, A. (2021) Pilot Randomized Controlled Trial of Virtual Reality vs. Standard-of-Care During Pediatric Laceration Repair. Journal of Child & Adolescent Trauma, 14, 295-298. https://doi.org/10.1007/s40653-021-00350-4
[31]
Litwin, S.P., Nguyen, C., Hundert, A., Stuart, S., Liu, D., et al. (2021) Virtual Reality to Reduce Procedural Pain during IV Insertion in the Pediatric Emergency Department: A Pilot Randomized Controlled Trial. Clinical Journal of Pain, 37, 94-101. https://doi.org/10.1097/AJP.0000000000000894
[32]
Dumoulin, S., Bouchard, S., Ellis, J., Lavoie, K.L., Vézina, M.P., et al. (2019) A Randomized Controlled Trial on the Use of Virtual Reality for Needle-Related Procedures in Children and Adolescents in the Emergency Department. Games for Health Journal, 8, 285-293. https://doi.org/10.1089/g4h.2018.0111
[33]
Bousquet, J., Heinzerling, L., Bachert, C., Papadopoulos, N.G., Bousquet, P.J., et al. (2012) Practical Guide to Skin Prick Tests in Allergy to Aeroallergens. Allergy, 67, 18-24. https://doi.org/10.1111/j.1398-9995.2011.02728.x
[34]
Cox, L., Nelson, H., Lockey, R., Calabria, C., Chacko, T., et al. (2011) Allergen Immunotherapy: A Practice Parameter Third Update. The Journal of Allergy and Clinical Immunology, 127, S1-S55.
[35]
Karaatmaca, B., Sahiner, U.M., Soyer, O. and Sekerel, B.E. (2021) The Impact of Skin Prick Testing on Pain Perception and Anxiety in Children and Parents. Allergologia et Immunopathologia, 49, 72-79. https://doi.org/10.15586/aei.v49i2.68
Jeffs, D.A. (2007) A Pilot Study of Distraction for Adolescents during Allergy Testing. Journal for Specialists in Pediatric Nursing, 12, 170-185. https://doi.org/10.1111/j.1744-6155.2007.00110.x
[38]
Zachariae, R. and Bjerring, P. (1990) The Effect of Hypnotically Induced Analgesia on Flare Reaction of the Cutaneous Histamine Prick Test. Archives of Dermatological Research, 282, 539-543. https://doi.org/10.1007/BF00371950
[39]
Requena, G., Sánchez, C., Corzo-Higueras, J.L., Reyes-Alvarado, S., Rivas-Ruiz, F., et al. (2014) Melomics Music Medicine (M3) to Lessen Pain Perception during Pediatric Prick Test procedure. Pediatric Allergy and Immunology: Official Publication of the European Society of Pediatric Allergy and Immunology, 25, 721-724. https://doi.org/10.1111/pai.12263
[40]
Goldberg, A., Stauber, T., Peleg, O., Hanuka, P., Eshayek, L. and Confino-Cohen, R. (2014) Medical Clowns Ease Anxiety and Pain Perceived by Children Undergoing Allergy Prick Skin Tests. Allergy, 69, 1372-1379. https://doi.org/10.1111/all.12463
[41]
Farrar, J.T., Portenoy, R.K., Berlin, J.A., Kinman, J.L. and Strom, B.L. (2000) Defining the Clinically Important Difference in Pain Outcome Measures. Pain, 88, 287-294. https://doi.org/10.1016/S0304-3959(00)00339-0
[42]
von Baeyer, C.L., Spagrud, L.J., McCormick, J.C., Choo, E., Neville, K. and Connelly, M.A. (2009) Three New Datasets Supporting Use of the Numerical Rating Scale (NRS-11) for Children’s Self-Reports of Pain Intensity. Pain, 143, 223-227. https://doi.org/10.1016/j.pain.2009.03.002
[43]
McGrath, P.J., Johnson, G.I., Goodman, J.T., Schillinger, J., Dunn, J. and Chapman, J. (1985) CHEOPS: A Behavioral Scale for Rating Postoperative Pain in Children. In: Fields, H.L., Ed., Advances in Pain Research, Raven, New York, 395-402.
[44]
Tyler, D.C., Tu, A., Douthit, J. and Chapman, R.C. (1993) Toward Validation of Pain Measurement Tools for Children: A Pilot Study. Pain, 52, 301-309. https://doi.org/10.1016/0304-3959(93)90163-J
[45]
Murphy, S., Greenspan, M., Jowdy, D. and Tammen, V. (1989) Development of a Brief Rating Instrument of Competitive Anxiety: Comparison with the CSAI-2. Association for the Advancement of Applied Sport Psychology, Seattle, WA.
[46]
Krane, V. (1994) The Mental Readiness Form as a Measure of Competitive State Anxiety. The Sport Psychologist, 8, 189-202. https://doi.org/10.1123/tsp.8.2.189
[47]
St Jacques, J. (2007) La Réalité Virtuelle: Une Solution Thérapeutique Visant à Augmenter l’Intéret et la Motivation envers le Traitement des Phobies Spécifiques chez l’Enfant? Ph.D. Dissertation, Université du Québec à Montréal (UQAM), Montréal. https://archipel.uqam.ca/9611/
[48]
Rizzo, A.A., Bowerly, T., Buckwalter, J.G., Schultheis, M., Matheis, R., et al. (2002) Virtual Environments for the Assessment of Attention and Memory Processes: The Virtual Classroom and Office. Proceedings of the International Conference on Disability, Virtual Reality and Associated Technology 2002 (ICDVRAT2002), Vesaprem, 17-19 September 2002, 10 p. https://infolab.usc.edu/DocsDemos/ICDVRAT2002.pdf
[49]
Witmer, B.G. and Singer, M.J. (1998) Measuring Presence in Virtual Environments: A Presence Questionnaire. Presence: Teleoperators and Virtual Environments, 7, 225-240. https://doi.org/10.1162/105474698565686
[50]
Kennedy, R.S., Lane, N.E., Berbaum, K.S. and Lilienthal, M.G. (1993) Simulator Sickness Questionnaire: An Enhanced Method for Quantifying Simulator Sickness. The International Journal of Aviation Psychology, 3, 203-220. https://doi.org/10.1207/s15327108ijap0303_3
[51]
Kianifard, F. and Gallo, P.P. (1995) Poisson Regression Analysis in Clinical Research. Journal of Biopharmaceutical Statistics, 5, 115-129. https://doi.org/10.1080/10543409508835101
[52]
Ballinger, G.A. (2004) Using Generalized Estimating Equations for Longitudinal Data Analysis. Organizational Research Methods, 7, 127-150. https://doi.org/10.1177/1094428104263672
[53]
Blouin, P., Yvert, M., Scaon, S., Jourdain, A., Lejars, O. and Colombat, P. (2011) Evaluation de la Douleur par les Enfants, les Parents, les Soignants et les Médecins lors des Ponctions Lombaires et Myélogrammes: Concordances ou Discordances. Douleurs: Evaluation-Diagnostic-Traitement, 12, 82-89. https://doi.org/10.1016/j.douler.2011.01.011
[54]
de Tovar, C., von Baeyer, C.L., Wood, C., Alibeu, J.P., Houfani, M. and Arvieux, C. (2010) Postoperative Self-report of Pain in Children: Interscale Agreement, Response to Analgesic and Preference for a Faces Scale and a Visual Analogue Scale. Pain Research and Management, 15, Article ID: 475907. https://doi.org/10.1155/2010/475907
[55]
Brudvik, C., Moutte, S.D., Baste, V. and Morken, T. (2017) A Comparison of Pain Assessment by Physicians, Parents and Children in an Outpatient Setting. Emergency Medicine Journal: EMJ, 34, 138-144. https://doi.org/10.1136/emermed-2016-205825
[56]
Wickens, C.D. (2008) Multiple Resources and Mental Workload. Human Factors, 50, 449-455. https://doi.org/10.1518/001872008X288394
[57]
Triberti, S., Repetto, C. and Riva, G. (2014) Psychological Factors Influencing the Effectiveness of Virtual Reality-Based Analgesia: A Systematic Review. Cyberpsychology, Behavior and Social Networking, 17, 335-345. https://doi.org/10.1089/cyber.2014.0054
[58]
Heeter, C. (1992) Being There: The Subjective Experience of Presence. Presence: Teleoperators and Virtual Environments, 1, 262-271. http://www.mitpressjournals.org/doi/10.1162/pres.1992.1.2.262
[59]
Lombard, M. and Ditton, T. (1997) At the Heart of It All: The Concept of Presence. Journal of Computer-Mediated Communication, 3, JCMC321. https://doi.org/10.1111/j.1083-6101.1997.tb00072.x
[60]
Bouchard S. (2011) Could Virtual Reality Be Effective in Treating Children with Phobias? Expert Review of Neurotherapeutics, 11, 207-213. https://doi.org/10.1586/ern.10.196
[61]
Stanney, K.M., Kennedy, R.S. and Kingdon, K. (2002) Virtual Environment Usage Protocols. In: Hale, K.S. and Stanney, K.M., Eds., Handbook of Virtual Environments: Design, Implementation and Applications, Lawrence Erlbaum Associates, London, 721-730.
[62]
Ahmadpour, N., Keep, M., Janssen, A., Rouf, A.S. and Marthick, M. (2020) Design Strategies for Virtual Reality Interventions for Managing Pain and Anxiety in Children and Adolescents: Scoping Review. JMIR Serious Games, 8, e14565. https://doi.org/10.2196/14565
[63]
Bailey, J.O. and Bailenson, J.N. (2017) Chapter 9: Immersive Virtual Reality and the Developing Child. In: Blumberg, F.C. and Brooks, P.J., Eds., Cognitive Development in Digital Contexts, Academic Press, Cambridge, 181-200. https://doi.org/10.1016/B978-0-12-809481-5.00009-2.
[64]
Gold, J.I., Kim, S.H., Kant, A.J., Joseph, M.H. and Rizzo, A.S. (2006) Effectiveness of Virtual Reality for Pediatric Pain Distraction during I.V. Placement. Cyberpsychology & Behavior: The Impact of the Internet, Multimedia and Virtual Reality on Behavior and Society, 9, 207-212. https://doi.org/10.1089/cpb.2006.9.207
