Virtual Reality as a Tool for Non-Pharmacologic Pediatric Chronic Pain Management: A Case Series
Jeong Han, BS1; Henry Huang, MD2,3; Chad Kelly, PT, DPT, DC4; Clint Fuller, MD2,3; Kathleen Chen, MD2,3; Jocelyn Gomez, PsyD4,5
1 Baylor College of Medicine, Houston, TX, USA; 2 Department of Anesthesiology, Perioperative & Pain Medicine, Texas Children’s Hospital, Houston TX, USA; 3Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA. 4Texas Children’s Hospital, Houston, TX, USA. 5Division of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Introduction
•Virtual reality (VR) is an effective tool in helping pediatric patients undergo painful procedures.1 However, research is limited on the effectiveness of VR for management of pediatric chronic pain.2
•Efficacy of VR as a tool for physical therapy (PT) for longitudinal, non-pharmacological management of pediatric chronic pain also remains poorly understood.
•We present the outcomes for two pediatric chronic pain patients who received VR as part of an interdisciplinary pain management treatment at a large pediatric hospital.
METHODS & CASE DESCRIPTION
•Methods:
•Inclusion criteria: patients who opted for a non-pharmacological treatment approach including physical therapy and psychotherapy.
•Outcome measures:
•Functional Disability Inventory (FDI) and Tampa Scale of Kinesiophobia (TSK).
•Qualitative data:
•Patients had the opportunity to describe their experiences including their satisfaction with VR.
•Patient 1 Case Description:
•8-year-old female with a seven-month history of worsening suprapubic pain following a dance injury.
•Pain refractory to ibuprofen and initial physical therapy.
•Patient struggled with anxiety and limitations with daily activities, including competitive dance.
•The patient received two sessions of physical therapy with six sets of VR exercise per session followed by four sessions without VR (Figure 1).
•Patient 2 Case Description:
•15-year-old female presenting with a three-year history of back pain that had progressed to diffuse amplified musculoskeletal pain syndrome.
•Heating pads, ibuprofen, and acetaminophen ultimately failed to alleviate symptoms.
•Pain severely impacted the patient’s mood, behavior, and sleep.
•Patient received seven sessions of physical therapy with four to eight sets of VR exercise per session and five sessions of physical therapy without VR (Figure 1).
DISCUSSION
•This preliminary study demonstrates the feasibility of using virtual reality as a tool for pediatric non-pharmacologic chronic pain management.
•Both patients received VR during their physical therapy and reported marked improvements.
•Despite patient 2 showing an increase in FDI and TSK score, indicating difficulties with physical functioning, it is important to note that these scores were obtained following volleyball camp. Therefore, patient appeared to experience pain following rigorous physical activities.
•Both patients demonstrated high satisfaction with VR exercise and cited VR as a helpful tool in PT
•Study limitations:
•Study would benefit from larger sample size and treatment protocol standardization.
•The use of validated outcome measures may contribute to an improved understanding of VR’s long-term impact.
CONCLUSION
•Virtual reality in physical therapy may be a feasible tool for non-pharmacological management of pediatric chronic pain.
•Future studies are needed to determine the longitudinal efficacy of VR as part of pediatric chronic pain treatment by measuring physical and psychological outcomes following treatment.
REFERENCES
1 Won AS, Bailey J, Bailenson J, Tataru C, Yoon IA, Golianu B. Immersive Virtual Reality for Pediatric Pain. Children. 2017;4(7):52. doi:10.3390/children4070052
2Logan DE, Khanna K, Randall E, O’Donnell S, Reks T, McLennan L. Centering Patient and Clinician Voices in Developing Tools to Address Pain Related School Impairment: A Phase I Study of a Virtual Reality School Simulation for Children and Adolescents with Chronic Pain. Child Basel Switz. 2023;10(10):1644. doi:10.3390/children10101644
