Novel Virtual Reality for Burn Wound Care Pain in Adolescents

Burn wounds cause intense, complex pain, and subsequent burn wound care causes further
intense, episodic pain that is often unrelieved by opioid and non-opioid medications,
resulting in under-treatment of pain. Further, opioid analgesics can have untoward side
effects including respiratory depression, nausea, constipation, pruritus, drowsiness,
lethargy, dependence, and induced hyperalgesia. As one of the most severe types of pain, burn
wound care pain adds to the trauma pediatric patients already experience from the burn itself
impacting quality of life with subsequent behavioral and maladaptive responses, such as
agitation, anger, anxiety, hyperactivity, uncooperativeness, aggression, and dissociation.
Lack of control over the procedure, pain memory, anxiety in anticipation of the repeated
painful nature of the procedure, and transmission of clinician distress associated with
inflicting procedural pain on the child contribute to the pain perceived.

Virtual reality (VR) shows great promise as an engaging, interactive, effective
non-pharmacologic intervention for various painful healthcare procedures, including burn
wound care, therapies, and chronic pain conditions, despite equivocal findings, perhaps due
to methodological issues. Designs of many studies of VR during burn wound care have been case
studies or carefully controlled within-subject designs; sample sizes have been small.
Recommendations for ongoing research include conducting more rigorous studies including
randomized controlled trials (RCTs), repeat design studies, testing VR throughout the
healthcare procedure, comparing VR to other distraction interventions; and using larger
sample sizes.

Primary Aim 1: Compare the effectiveness of age-appropriate, consumer available, high
technology, interactive VR with standard care (SC) on adolescents' acute procedural pain
intensity perception during burn wound care treatment in the ambulatory outpatient clinic
setting.