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

项目摘要/摘要 儿童阿片类药物的使用是一种公共健康危机。在儿童中，处方阿片类药物是非 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一种 已知的成年依赖和药物滥用障碍的“门户”。尽管多年来的研究，阿片类药物 仍然是癌症儿童最常用的止痛药。这些孩子们经历了 从确诊时到成年后作为幸存者的疼痛，主要来自癌症的治疗。这个 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以治愈或 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，大手术 增加新发病和长期使用阿片类药物的风险。传统网络的高成本和缺乏可扩展性 用于控制疼痛的基于分心的医疗设备，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，因此有感染疾病的风险 来自共享设备的传输是一个额外的、可能危及生命的问题。 移动增强现实应用消除了这些限制，代表着一种经济、安全和 商业上可行的危重儿童疼痛管理的辅助工具。我们的目标是减少长期的 阿片类药物在接受大手术的癌症儿童中的使用 清道夫狩猎式的手机AR游戏，而他们正在医院康复。为了实现这一目标，我们有 与MD Anderson癌症的儿科肿瘤学家、麻醉师和疼痛专家合作 中心和贝勒医学院(德克萨斯儿童医院)。在第一阶段，我们将演示 研究增强现实结合空间增强)游戏的可行性 减少住院患者术后病房阿片类药物的使用。在第二阶段，我们将评估 减少癌症儿童术后即刻和长期阿片类药物使用的游戏 一项多点随机对照临床试验中与主要治疗相关的手术(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，这是第一个调查移动电话的RCT 增强现实用于儿童癌症患者的阿片类药物减少或任何 儿科人口。由于大多数患有癌症的儿童有望长期存活，因此 在这一高风险、顽固性疼痛人群中减少和预防长期使用阿片类药物将持续终生 像个孩子一样。

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.