JMIR Publications

ABSTRACT

Background:

Ineffective postoperative pain management is associated with several negative consequences, including increased morbidity, impaired physical function and quality of life, delayed recovery, prolonged opioid use during and after hospitalization, and increased healthcare costs. Traditional pain management therapies, including pharmacological interventions, have several drawbacks, particularly in children, with growing concerns over long-term opioid abuse. Virtual reality (VR) has emerged as a promising non-pharmacological intervention for pain management in various clinical settings. VR technology immerses individuals in computer-generated environments, providing them with multisensory experiences that can distract and engage their attention, ultimately reducing their perception of pain.

Objective:

The objective of our study was to address the major concepts related to VR, the use of VR in differing clinical situations, various VR-based therapy methods, and the practicality of VR to alleviate pain, as well as several key findings to date and future directions.

Methods:

Articles from database inception through January 2023 were searched in PubMed, EMBASE, PsycINFO, and CINAHL electronic database. Search terms included "virtual reality", "video games", "pediatrics" and keywords included "VR" and "postoperative pain ". The review included randomized clinical trials, observational studies, cohort studies, and case-control studies evaluating VR interventions for postoperative pain management in pediatric populations.

Results:

Eight studies were analyzed, including 6 randomized controlled trials and 2 prospective pilot studies. Studies investigated various VR modalities: distraction therapy (VR-D), exposure therapy (VR-E), guided relaxation (VR-GR), and biofeedback (VR-BF). VR interventions demonstrated significant reductions in pre- and post-operative anxiety and fear scores, with superior pain control compared to traditional distraction methods. One large trial found no significant impact on anxiety or emergence delirium but showed clinically important reduction in rescue analgesia following more painful surgeries. Common limitations included lack of standardization in VR session timing, potential self-reporting bias, and varying control group designs.

Conclusions:

This systematic review suggests that VR is a promising emerging non-pharmacological intervention for perioperative pain management in pediatric patients. Future studies should standardize perioperative and postoperative protocols to investigate optimal timing and frequency of VR use, as well as investigate long term outcomes.