Virtual Reality and Acute Pain Management for Children

描述（由申请人提供）：拟议研究的目的是测试基于虚拟现实（VR）的交互式分心对儿童急性疼痛管理的有效性。为了实现这一总体目标，提出的一系列研究将：1)测试VR的互动性是否对其在急性实验室疼痛体验（冷压力）中作为分心物的有效性起关键作用；2)测试通过VR技术提供的交互式分心是否比不使用VR技术提供的交互式分心更有效地减轻冷压力疼痛；3)使用比文献中使用的更年轻的儿童样本（即包括6-8岁儿童以及年龄较大的小学和中学儿童的样本）来测试VR分心的有效性；4)通过对血液学肿瘤学患者进行VR分心的先导试验，检验实验室结果是否可以推广到血液学患者的临床人群；5)检查儿童年龄和儿童焦虑是否可能成为治疗结果的调节因子。提出了三项研究。研究1在实验室冷压任务中测试了交互式和被动VR分心。66名儿童将完成基线冷压试验，然后将被分配到两个实验分心条件之一或第二个冷压试验的控制条件。研究2对90名接受实验室冷压任务的儿童进行了有和没有VR技术的互动分心测试。将采用与研究1类似的3（实验组）× 2（冷压试验）混合设计。在这两项研究中，儿童在分散注意力条件下表现出疼痛耐受性、疼痛阈值和感知疼痛强度的改善。然而，在研究1中，交互式VR分心被期望优于被动VR分心。在研究2中，有VR的交互分心预期优于没有VR的交互分心。研究3测试了基于VR的交互式分心在临床环境中的适用性。在交替治疗设计中，接受反复血液学检查的儿童试点样本将接受有无VR技术的交互式分心治疗。与基线相比，在两种分心条件下，医疗过程中疼痛的自我报告和明显的行为困扰都较低，使用VR技术的好处最大。

DESCRIPTION (provided by applicant): The objective of the proposed study is to test the effectiveness of virtual reality (VR) based interactive distraction for acute pain management in children. To accomplish this general goal, the proposed series of studies will: 1) Test whether the interactive nature of VR is a critical contributor to its effectiveness as a distractor during an acute laboratory pain experience (cold pressor); 2) Test whether interactive distraction is more effective in reducing cold pressor pain when provided via VR technology than when provided without the use of VR technology; 3) Test the effectiveness of VR distraction with a younger sample of children than has been used in the literature (i.e., a sample that includes 6-8-year-old children in addition to older elementary and middle school aged children); 4) Test whether findings obtained in the laboratory generalize to a clinical population of hematology patients by conducting a pilot test of VR distraction with Hematology-Oncology patients; and 5) Examine the role of child age and child anxiety as possible moderators of treatment outcome. Three studies are proposed. Study 1 tests interactive versus passive VR distraction during a laboratory cold pressor task. Sixty-six children will complete a baseline cold pressor trial and will then be assigned to one of the two experimental distraction conditions or to a control condition for the second cold pressor trial. Study 2 tests interactive distraction with and without VR technology with 90 children undergoing a laboratory cold pressor task. A 3 (experimental group) by 2 (cold pressor trials trials) mixed design similar to Study 1 will be used. In both studies, children are expected to demonstrate improvements in pain tolerance, pain threshold, and perceived pain intensity during the distraction conditions. However, in study 1, interactive VR distraction is expected to be superior to passive VR distraction. In Study 2, interactive distraction with VR is expected to be superior to interactive distraction without VR. Study 3 tests the applicability of VR based interactive distraction to the clinical setting. A pilot sample of children undergoing repeated hematological procedures will receive interactive distraction with and without VR technology in an alternating treatments design. Self report of pain during medical procedures and overt behavioral distress are expected to be lower in both distraction conditions relative to baseline, with the greatest benefits evident when VR technology is used.