M. Joseph

Effectiveness of Virtual Reality for Pediatric Pain Distraction during IV Placement

The objective of this study was to test the efficacy and suitability of virtual reality (VR) as a pain distraction for pediatric intravenous (i.v.) placement. Twenty children (12 boys, 8 girls) requiring i.v. placement for a magnetic resonance imaging/computed tomography (MRI/CT) scan were randomly assigned to two conditions: (1) VR distraction using Street Luge (5DT), presented via a head-mounted display, or (2) standard of care (topical anesthetic) with no distraction. Children, their parents, and nurses completed self-report questionnaires that assessed numerous health-related outcomes. Responses from the Faces Pain Scale-Revised indicated a fourfold increase in affective pain within the control condition; by contrast, no significant differences were detected within the VR condition. Significant associations between multiple measures of anticipatory anxiety, affective pain, i.v. pain intensity, and measures of past procedural pain provided support for the complex interplay of a multimodal assessment of pain perception. There was also a sufficient amount of evidence supporting the efficacy of Street Luge as a pediatric pain distraction tool during i.v. placement: an adequate level of presence, no simulator sickness, and significantly more child-, parent-, and nurse-reported satisfaction with pain management. VR pain distraction was positively endorsed by all reporters and is a promising tool for decreasing pain, and anxiety in children undergoing acute medical interventions. However, further research with larger sample sizes and other routine medical procedures is warranted.

Pediatric chronic pain and health-related quality of life.

The aim of this study was to investigate the health-related quality of life (HRQOL) of children and adolescents with chronic pain. Sixty-nine participants (53 girls and 16 boys, 8-18 years old) were recruited, along with their caregivers, from an outpatient pain management clinic. Participants completed questionnaires regarding the childs pain intensity and HRQOL (physical, emotional, social, and school functioning). Findings indicated that children with chronic pain report significantly lower HRQOL scores compared to population-based normative data and data of children with other chronic illnesses. Lower levels of pain were associated with higher HRQOL scores. In addition to targeting pain management, interventions focused on emotional health are necessary to enhance health outcomes for children with chronic pain.

Touch and Massage for Medically Fragile Infants

Research investigating the efficacy of infant massage has largely focused on premature and low birth weight infants. The majority of investigations have neglected highly acute patients in academic neonatal intensive care units (NICUs). The current study was developed with two aims: (Phase 1) to develop, implement and demonstrate the feasibility and safety of a parent-trained compassionate touch/massage program for infants with complex medical conditions and (Phase 2) to conduct a longitudinal randomized control trial (RCT) of hand containment/massage versus standard of care in a level III academic Center for Newborn and Infant Critical Care (CNICC). Certified infant massage instructors (CIMIs) taught parents to massage their hospitalized infants. Massage therapy and instruction were performed for seven consecutive days and health outcomes were collected for up to 1 month following treatment. Caregivers, nurses and certified infant massage therapists indicated moderate to high levels of satisfaction and feasibility with the implementation of hand containment/massage in a level III academic center CNICC. In addition, infant behavioral and physiological measures were within safe limits during the massage sessions. All caregivers participating in the massage group reported high levels of satisfaction 7 days into the intervention and at the 1-month follow-up with regards to their relationship with their infant, the massage programs impact on that relationship and the massage program. Due to unequal and small sample sizes, between group analyses (control versus massage) were not conducted. Descriptive infant characteristics of health outcomes are described. Preliminary data from this study indicates feasibility and safety of infant massage and satisfaction among the caregivers, CIMIs and the nurses in the CNICC. An important contribution from this study was the demonstration of the infants’ safety based on physiological stability and no change in agitation/pain scores of the infants receiving massage. Massage in a tertiary urban academic NICU continues to be an area of needed study. Future studies examining infant health outcomes, such as weight gain, decreased length of hospitalization and caregiver–infant bonding, would provide greater insight into the impact of massage for medically fragile infants.