JMIR Publications

ABSTRACT

Background:

The use of extended reality (XR), including virtual reality (VR) and augmented reality (AR) for treating pain has accelerated in the last 10 years. XR is an attractive biobehavioral intervention that may support management of pain and/or pain related disability. Reviews of adult literature report promising results, particularly for acute procedural pain.

Objective:

This study aimed to (1) summarize the available evidence with respect to feasibility, safety, and effectiveness [pain intensity] of XR for pediatric acute and chronic pain, (2) summarize assessment tools used to measure study outcomes, and (3) identify gaps in evidence to guide future research efforts.

Methods:

This study is a systematic review of the literature. Multiple databases were searched from inception until March 2023: CINAHL, Cochrane Central, Embase, MEDLINE, PsycINFO. Titles, abstracts and full-texts articles were reviewed by two team members to determine eligibility. Articles were included if: (1) participants were aged 0-18 years; (2) study intervention was VR or AR; (3) study outcomes included safety, feasibility, acceptability, and/or effectiveness on the outcome of pain; and (4) study design was observational or interventional. Data were collected on bibliographic information, study characteristics, XR characteristics, outcome domains, and outcome measures, study findings pertaining to safety, feasibility, and effectiveness.

Results:

Ninety articles were included in the review. All included studies used VR and 93% (n=84) studied VR in the context of acute pain. Seventy-four studies were randomized trials, and 16 studies were observational. Safety was assessed in 23 studies of acute pain, with 13 studies reporting no adverse events and 10 studies reported events of low concern. Feasibility was assessed in 27 studies. Of the 84 studies of acute pain, 62% studies reported a positive effect on pain intensity, 21% reported no effect, and 13% reported mixed effects. All 6 studies in chronic pain reported a positive effect on pain intensity. An evidence gap map is used to illuminate gaps in specific research areas stratified by sub-types of pain. Risk of bias assessment revealed 67 studies had a moderate risk of bias, 17 studies had a high risk, and 5 studies were deemed to be low risk.

Conclusions:

The current body of literature around XR in pediatric pain is focused on acute pain with promising results of safety and effectiveness on pain intensity. The literature pertaining to chronic pain lags behind, limiting our ability to draw conclusions. Study risk of bias is problematic in this field with the inherent challenge of blinding participants and researchers to the intervention. Future research should aim to measure effectiveness beyond pain intensity with a consistent approach to measuring key outcome domains and measures. Current efforts are underway to establish expert consensus on best research practices in this field. Clinical Trial: PROSPERO # CRD42022307153