An augmented reality platform to reduce post-operative and chronic opioid use in pediatric cancer

项目总结/摘要 儿童阿片类药物使用是一场公共卫生危机。在儿童中，处方阿片类药物是非阿片类药物的主要来源。 医疗滥用以及与阿片类药物有关的住院和死亡。儿童早期使用阿片类药物是 已知的成年依赖和药物滥用障碍的“门户”。尽管经过多年的研究， 仍然是癌症儿童最常用的止痛药。这些孩子经历 从诊断到成年的幸存者的痛苦，主要是从他们的癌症治疗。的 大多数儿童癌症患者在大手术后的几个月内持续使用阿片类药物， 来治疗他们的疾病更令人担忧的是，对儿童癌症幸存者的研究表明， 增加新发和慢性阿片类药物使用的风险。传统的高成本和缺乏可扩展性 用于管理疼痛的基于分心的医疗设备，例如虚拟现实耳机，限制了它们的临床影响 和商业潜力。由于癌症患者通常免疫功能低下， 来自共享设备的传播是一个额外的、可能危及生命的问题。 移动的增强现实应用消除了这些限制，代表了一种具有成本效益的，安全的， 用于危重儿童疼痛管理的商业上可行的治疗工具。我们的目标是减少长期 阿片类药物在接受大手术的癌症儿童中的使用， 清道夫狩猎风格的移动的AR游戏，而他们正在医院恢复。为了实现这一目标，我们 我与MD安德森癌症中心的儿科肿瘤学家、麻醉学家和疼痛专家合作 中心和贝勒医学院（得克萨斯州儿童医院）。在第一阶段，我们将展示 ARISE（增强现实空间增强）游戏的可行性， 减少住院术后病房的阿片类药物消耗。在第二阶段，我们将评估 游戏，以减少癌症儿童术后立即和长期阿片类药物的使用， 一项多中心随机对照临床试验中的重大治疗相关手术（AURORA试验：增强 儿童癌症中阿片类药物减少的现实）。据我们所知，这是第一个研究移动的 增强现实用于儿科癌症患者的阿片类药物减少或任何患者的术后阿片类药物减少 儿科人群。由于大多数癌症儿童预计可以长期生存，因此 减少和预防这一高风险、难治性疼痛人群的慢性阿片类药物使用将持续一生。 一个孩子。

PROJECT SUMMARY/ABSTRACT Pediatric opioid use is a public health crisis. In children, prescription opioids are the primary source of non- medical abuse as well as opioid-associated hospitalizations and deaths. Early opioid use in childhood is a known “gateway” to adulthood dependence and substance abuse disorders. Despite years of research, opioids remain the most commonly prescribed pain medication for children with cancer. These children experience pain from the time of diagnosis into adulthood as survivors, primarily from the treatment for their cancer. The majority of pediatric cancer patients have persistent opioid use in the months following major surgery to cure or to treat their disease. More concerning, studies in childhood cancer survivors show that major surgery increases risk of new-onset and chronic opioid use. The high costs and lack of scalability of traditional distraction-based medical devices for managing pain, such as virtual reality headsets, limit their clinical impact and commercial potential. As cancer patients are often immunocompromised, risk from infectious disease transmission from sharing devices is an additional, possibly life-threatening, concern. Mobile augmented reality applications eliminate these limitations, representing a cost-effective, safe and commercially viable adjunctive tool for pain management in critically ill children. Our goal is to reduce long-term opioid use in children with cancer undergoing major surgery by distracting them from their pain with a scavenger hunt-style mobile AR game while they are recovering in the hospital. To achieve this goal, we have collaborated with pediatric oncologists, anesthesiologists and pain specialists at the MD Anderson Cancer Center and the Baylor College of Medicine (Texas Children’s Hospital). In Phase I, we will demonstrate the feasibility of investigating the ARISE (Augmented Reality Incorporating Spatial Enhancement) game for reducing opioid consumption in the inpatient postoperative wards. In Phase II, we will evaluate the efficacy of the game to reduce immediate and long-term postoperative opioid use in children with cancer undergoing major treatment-related surgery in a multi-site randomized controlled clinical trial (AURORA trial: Augmented Reality for Opioid Reduction in Childhood Cancer). To our knowledge, this is the first RCT to investigate mobile augmented reality for opioid reduction in pediatric cancer patients or for postoperative opioid reduction in any pediatric population. As the majority of children with cancer are expected to survive long-term, the benefits of reducing and preventing chronic opioid use in this high-risk, refractory pain population will last over the lifetime of a child.