Mobile virtual reality distraction reduces needle pain and stress in children?
Vol.14,No.1(2020)
Virtual reality (VR) technology is a remarkably effective method for distracting attention from painful stimuli. This is particularly important for children who undergo painful and stressful medical treatments. The main aim of the present study was to examine whether the type of VR distraction had an effect on reducing pain and stress in children during a short blood sampling treatment, and to investigate the effectiveness of mobile VR.
Fifty-seven patients of a pediatric nephrology clinic (Mage = 12, range: 7–17) participated in a between-group experimental design study. Participants in the treatment group (active vs passive VR) underwent a venipuncture procedure with VR distraction. Mobile VR (Samsung gear) was used in this study. Participants in the active VR experimental condition played a game based on the multiple object tracking task paradigm. In the passive VR experimental condition, participants watched a film similar to the presented game. All participants rated their pain and stress levels on the Visual Analogue Scale and completed a short questionnaire.
Both VR groups reported significantly lower pain and stress intensity than the control group. When comparing the two experimental groups, no statistically significant differences were found, although participants differed in their level of perceived pain and stress, with greater benefits in the active VR. The present study focused on comparing the effect sizes of active and passive VR interventions. Additionally, the study confirmed feasibility of using Multiple Object Tracking paradigm as a method of attention distraction in VR.
Children; pain; acute care; virtual reality; analgesia
Joanna Ewa Piskorz
University of Wroclaw
Institute of Psychology, University of Wroclaw, Ph. D.
ul. Dawida 1, 50-527 WROCŁAW,
TEL. +48 71 367 20 01 w. 126 , FAX. +48 71 367 18 14,
psychologia@uwr.edu.pl
Assistant Professor of Psychology, University of Wroclaw. Since 2000 is researching VR use in psychology. Since 2012 works in “VR4Health” project, studying VR use in pain alleviation, both in experimental pain paradigms, and clinical settings.
Marcin Czub
University of Wroclaw
Institute of Psychology, University of Wroclaw, Ph. D.
ul. Dawida 1, 50-527 WROCŁAW,
TEL. +48 71 367 20 01 w. 126 , FAX. +48 71 367 18 14,
psychologia@uwr.edu.pl
Assistant professor at the Institute of Psychology, University of Wrocław, Poland. Lead researcher in “VR4Health” – a research project on Virtual Reality and pain perception. His research and teaching are focused on body perception, cognitive psychology, pain perception, and virtual reality. Laureate of Foundation for Polish Science prize for educational project “Being an avatar – Virtual Reality and the psychology of body perception”
Beata Šulžickaja
University of Wroclaw
Institute of Psychology, University of Wroclaw
ul. Dawida 1, 50-527 WROCŁAW,
TEL. +48 71 367 20 01 w. 126 , FAX. +48 71 367 18 14,
psychologia@uwr.edu.pl
Holder of a master’s degree in psychology, graduated in 2015. Deeply interested in neuroscience and the therapeutic potential of Virtual Reality in reducing pain, stimulating intellectual capacity and improving mental health. In collaboration with VR4Health and the University of Wrocław since 2017.
Katarzyna Kiliś-Pstrusińska
Wroclaw Medical University
Prof. Katarzyna Kilis-Pstrusinska, MD, PhD,
Dept. of Paediatric Nephrology, Wroclaw Medical University,
ul. Borowska 213, 50-556 Wroclaw, Poland
tel. +48 717364400; fax: +48 717364409
Professor of Medicine, MD, PhD, psychologist, Wroclaw Medical University.
Interested in health related quality of life in children with chronic kidney diseases,
collaborating with several centers of pediatric nephrology and pediatrics.
Allison, D., Wills, B., Bowman, D., Wineman, J., & Hodges, L. F. (1997). The virtual reality gorilla exhibit. IEEE Computer Graphics and Applications, 17(6), 30–38. https://doi.org/10.1109/38.626967
Alvarez, G. A., & Scholl, B. J. (2005). How does attention select and track spatially extended objects? New effects of attentional concentration and amplification. Journal of Experimental Psychology: General, 134(4), 461–476. https://doi.org/10.1037/0096-3445.134.4.461
Birnie, K. A., Noel, M., Parker, J. A., Chambers, C. T., Uman, L. S., Kisely, S. R., & McGrath, P. J. (2014). Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents. Journal of Pediatric Psychology, 39(8), 783–808. https://doi.org/10.1093/jpepsy/jsu029
Chan, E. A., Chung, J. W., Wong, T. K., Lien, A. S., & Yang, J. Y. (2007). Application of a virtual reality prototype for pain relief of pediatric burn in Taiwan. Journal of Clinical Nursing, 16(4), 786–793. https://doi.org/10.1111/j.1365-2702.2006.01719.x
Chirico, A., Lucidi, F., De Laurentiis, M., Milanese, C., Napoli, A., & Giordano, A. (2016a). Virtual reality in health system: Beyond entertainment. A mini‐review on the efficacy of VR during cancer treatment. Journal of Cellular Physiology, 231(2), 275–287. https://doi.org/10.1002/jcp.25117
Chirico, A., D’Aiuto, M., Pinto, M., Milanese, C., Napoli, A., Avino, F., Iodice, G., Russo, G., De Laurentiis, M., Ciliberto, G., Giordano, A., & Lucidi, F. (2016b). The elapsed time during a virtual reality treatment for stressful procedures: A pool analysis on breast cancer patients during chemotherapy. In G. De Pietro, L. Gallo, R. J. Howlett, & L. C. Jain (Eds.), Intelligent Interactive Multimedia Systems and Services 2016 (pp. 731–738). Springer. https://doi.org/10.1007/978-3-319-39345-2_65
Cohen, L. L., Cousins, L. A., & Martin, S. R. (2014). Procedural pain distraction. In P. J. McGrath, B. J. Stevens, S. M. Walker, & W. T. Zempsky (Eds.), Oxford textbook of paediatric pain (pp. 553–559). Oxford University Press. https://doi.org/10.1093/med/9780199642656.003.0053
Czub, M., & Piskorz, J. (2018). Body movement reduces pain intensity in virtual reality–based analgesia. International Journal of Human–Computer Interaction, 34(11), 1045–1051. https://doi.org/10.1080/10447318.2017.1412144
Dahlquist, L. M., McKenna, K. D., Jones, K. K., Dillinger, L., Weiss, K. E., & Ackerman, C. S. (2007). Active and passive distraction using a head-mounted display helmet: Effects on cold pressor pain in children. Health Psychology, 26(6), 794–801. https://doi.org/10.1037/0278-6133.26.6.794
Das, D. A., Grimmer, K. A., Sparnon, A. L., McRae, S. E., & Thomas, B. H. (2005). The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: A randomized controlled trial [ISRCTN87413556]. BMC Pediatrics, 5, Article 1. https://doi.org/10.1186/1471-2431-5-1
Eccleston, C., & Crombez, G. (1999). Pain demands attention: A cognitive–affective model of the interruptive function of pain. Psychological Bulletin, 125(3), 356–366. https://doi.org/10.1037/0033-2909.125.3.356
Fougnie, D., & Marois, R. (2006). Distinct capacity limits for attention and working memory: Evidence from attentive tracking and visual working memory paradigms. Psychological Science, 17(6), 526–534. https://doi.org/10.1111/j.1467-9280.2006.01739.x
Fowler-Kerry, S., & Lander, J. R. (1987). Management of injection pain in children. PAIN, 30(2), 169–175. https://doi.org/10.1016/0304-3959(87)91072-4
Fradet, C., McGrath, P. J., Kay, J., Adams, S., & Luke, B. (1990). A prospective survey of reactions to blood tests by children and adolescents. PAIN, 40(1), 53–60. https://doi.org/10.1016/0304-3959(90)91050-S
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133(4), 581–624. https://doi.org/10.1037/0033-2909.133.4.581
Gershon, J., Zimand, E., Pickering, M., Rothbaum, B. O., & Hodges, L. (2004). A pilot and feasibility study of virtual reality as a distraction for children with cancer. Journal of the American Academy of Child & Adolescent Psychiatry, 43(10), 1243–1249. https://doi.org/10.1097/01.chi.0000135621.23145.05
Gold, J. I., & Mahrer, N. E. (2017). Is virtual reality ready for prime time in the medical space? A randomized control trial of pediatric virtual reality for acute procedural pain management. Journal of Pediatric Psychology, 43(3), 266–275. https://doi.org/10.1093/jpepsy/jsx129
Gold, J. I., Kim, S. H., Kant, A. J., Joseph, M. H., & Rizzo, A. S. (2006). Effectiveness of virtual reality for pediatric pain distraction during IV placement. CyberPsychology & Behavior, 9(2), 207–212. https://doi.org/10.1089/cpb.2006.9.207
Goodenough, B., Kampel, L., Champion, G. D., Laubreaux, L., Nicholas, M. K., Ziegler, J. B., & McInerney, M. (1997). An investigation of the placebo effect and age-related factors in the report of needle pain from venipuncture in children. PAIN, 72(3), 383–391. https://doi.org/10.1016/S0304-3959(97)00062-6
Hoffman, H. G., Chambers, G. T., Meyer, W. J., III., Arceneaux, L. L., Russell, W. J., Seibel, E. J., Richards, T. L., Sharar, S. R., & Patterson, D. R. (2011). Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Annals of Behavioral Medicine, 41(2), 183–191. https://doi.org/10.1007/s12160-010-9248-7
Hoffman, H. G., Garcia-Palacios, A., Kapa, V., Beecher, J., & Sharar, S. R. (2003). Immersive virtual reality for reducing experimental ischemic pain. International Journal of Human–Computer Interaction, 15(3), 469–486. https://doi.org/10.1207/S15327590IJHC1503_10
Hoffman, H. G., Richards, T. L., Bills, A. R., Van Oostrom, T., Magula, J., Seibel, E. J., & Sharar, S. R. (2006). Using fMRI to study the neural correlates of virtual reality analgesia. CNS Spectrums, 11(1), 45–51. https://doi.org/10.1017/S1092852900024202
Hoffman, H. G., Seibel, E. J., Richards, T. L., Furness, T. A., III., Patterson, D. R., & Sharar, S. R. (2006). Virtual reality helmet display quality influences the magnitude of virtual reality analgesia. The Journal of Pain, 7(11), 843–850. https://doi.org/10.1016/j.jpain.2006.04.006
Hoffman, H. G., Sharar, S. R., Coda, B., Everett, J. J., Ciol, M., Richards, T., & Patterson, D. R. (2004). Manipulating presence influences the magnitude of virtual reality analgesia. PAIN, 111(1), 162–168. https://doi.org/10.1016/j.pain.2004.06.013
Indovina, P., Barone, D., Gallo, L., Chirico, A., De Pietro, G., & Giordano, A. (2018). Virtual reality as a distraction intervention to relieve pain and distress during medical procedures. The Clinical Journal of Pain, 34(9), 858–877. https://doi.org/10.1097/AJP.0000000000000599
Jacobson, R. M., Swan, A., Adegbenro, A., Ludington, S. L., Wollan, P. C., Poland, G. A., & Vaccine Research Group. (2001). Making vaccines more acceptable—methods to prevent and minimize pain and other common adverse events associated with vaccines. Vaccine, 19(17-19), 2418–2427. https://doi.org/10.1016/S0264-410X(00)00466-7
Jeffs, D., Dorman, D., Brown, S., Files, A., Graves, T., Kirk, E., Meredith-Neve, S., Sanders, J., White, B., & Swearingen, C. J. (2014). Effect of virtual reality on adolescent pain during burn wound care. Journal of Burn Care & Research, 35(5), 395–408. https://doi.org/10.1097/BCR.0000000000000019
Kelley, M. L., Jarvie, G. J., Middlebrook, J. L., McNeer, M. F., & Drabman, R. S. (1984). Decreasing burned children’s pain behavior: Impacting the trauma of hydrotherapy. Journal of Applied Behavior Analysis, 17(2), 147–158. https://doi.org/10.1901/jaba.1984.17-147
Kenney, M. P., & Milling, L. S. (2016). The effectiveness of virtual reality distraction for reducing pain: A meta-analysis. Psychology of Consciousness: Theory, Research, and Practice, 3(3), 199–210. https://doi.org/10.1037/cns0000084
Kirby, K. N., & Gerlanc, D. (2013). BootES: An R package for bootstrap confidence intervals on effect sizes. Behavior research methods, 45(4), 905-927. https://doi.org/10.3758/s13428-013-0330-5
MacLaren, J. E., & Cohen, L. L. (2005). A comparison of distraction strategies for venipuncture distress in children. Journal of Pediatric Psychology, 30(5), 387–396. https://doi.org/10.1093/jpepsy/jsi062
Magora, F., Cohen, S., Shochina, M., & Dayan, E. (2006). Virtual reality immersion method of distraction to control experimental ischemic pain. The Israel Medical Association Journal, 8(4), 261–265.
Manne, S. L., Redd, W. H., Jacobsen, P. B., Gorfinkle, K., Schorr, O., & Rapkin, B. (1990). Behavioral intervention to reduce child and parent distress during venipuncture. Journal of Consulting and Clinical Psychology, 58(5), 565–572. https://doi.org/10.1037/0022-006X.58.5.565
Mason, S., Johnson, M. H., & Woolley, C. (1999). A comparison of distractors for controlling distress in young children during medical procedures. Journal of Clinical Psychology in Medical Settings, 6(3), 239–248. https://doi.org/10.1023/A:1026235620538
McCaul, K. D., & Malott, J. M. (1984). Distraction and coping with pain. Psychological Bulletin, 95(3), 516–533. https://doi.org/10.1037/0033-2909.95.3.516
Melzack, R. (2001). Pain and the neuromatrix in the brain. Journal of Dental Education, 65(12), 1378–1382. http://www.jdentaled.org/content/65/12/1378
National Academies of Sciences, Engineering, and Medicine. (2017). Pain management and the opioid epidemic: Balancing societal and individual benefits and risks of prescription opioid use. The National Academies Press. https://doi.org/10.17226/24781
Nilsson, S., Enskär, K., Hallqvist, C., & Kokinsky, E. (2013). Active and passive distraction in children undergoing wound dressings. Journal of Pediatric Nursing, 28(2), 158–166. https://doi.org/10.1016/j.pedn.2012.06.003
Nilsson, S., Finnström, B., Kokinsky, E., & Enskär, K. (2009). The use of Virtual Reality for needle-related procedural pain and distress in children and adolescents in a paediatric oncology unit. European Journal of Oncology Nursing, 13(2), 102–109. https://doi.org/10.1016/j.ejon.2009.01.003
O'Hearn, K., Landau, B., & Hoffman, J. E. (2005). Multiple object tracking in people with Williams syndrome and in normally developing children. Psychological science, 16(11), 905-912. https://doi.org/10.1111/j.1467-9280.2005.01635.x
Piskorz, J., & Czub, M. (2018). Effectiveness of a virtual reality intervention to minimize pediatric stress and pain intensity during venipuncture. Journal for Specialists in Pediatric Nursing, 23(1), Article e12201. https://doi.org/10.1111/jspn.12201
Ploghaus, A., Narain, C., Beckmann, C. F., Clare, S., Bantick, S., Wise, R., Matthews, P. M., Rawlins, J. N. P., & Tracey, I. (2001). Exacerbation of pain by anxiety is associated with activity in a hippocampal network. The Journal of Neuroscience, 21(24), 9896–9903. https://doi.org/10.1523/JNEUROSCI.21-24-09896.2001
Postle, B. R., D’Esposito, M., & Corkin, S. (2005). Effects of verbal and nonverbal interference on spatial and object visual working memory. Memory & Cognition, 33(2), 203–212. https://doi.org/10.3758/BF03195309
Powers, S. W., Blount, R. L., Bachanas, P. J., Cotter, M. W., & Swan, S. C. (1993). Helping preschool leukemia patients and their parents cope during injections. Journal of Pediatric Psychology, 18(6), 681–695. https://doi.org/10.1093/jpepsy/18.6.681
Rehman, A. U., Kihara, K., Matsumoto, A., & Ohtsuka, S. (2015). Attentive tracking of moving objects in real 3D space. Vision Research, 109(Part A), 1–10. https://doi.org/10.1016/j.visres.2015.02.004
Schneider, S. M., & Hood, L. E. (2007). Virtual reality: A distraction intervention for chemotherapy. Oncology Nursing Forum, 34(1), 39–46. https://doi.org/10.1188/07.ONF.39-46
Schneider, S. M., Kisby, C. K., & Flint, E. P. (2011). Effect of virtual reality on time perception in patients receiving chemotherapy. Supportive Care in Cancer, 19(4), 555-564. https://doi.org/10.1007/s00520-010-0852-7
Scholl, B. J. (2009). What have we learned about attention from multiple object tracking (and vice versa)? In D. Dedrick & L. Trick (Eds.), Computation, cognition, and Pylyshyn (pp. 49–77). MIT Press.
Triberti, S., Repetto, C., & Riva, G. (2014). Psychological factors influencing the effectiveness of virtual reality–based analgesia: A systematic review. Cyberpsychology, Behavior, and Social Networking, 17(6), 335–345. https://doi.org/10.1089/cyber.2014.0054
Trick, L. M., Guindon, J., & Vallis, L. A. (2006). Sequential tapping interferes selectively with multiple-object tracking: Do finger-tapping and tracking share a common resource? The Quarterly Journal of Experimental Psychology, 59(7), 1188–1195. https://doi.org/10.1080/17470210600673990
Villemure, C., & Bushnell, C. M. (2002). Cognitive modulation of pain: How do attention and emotion influence pain processing? PAIN, 95(3), 195–199. https://doi.org/10.1016/S0304-3959(02)00007-6
Windich-Biermeier, A., Sjoberg, I., Dale, J. C., Eshelman, D., & Guzzetta, C. E. (2007). Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer. Journal of Pediatric Oncology Nursing, 24(1), 8–19. https://doi.org/10.1177/1043454206296018
Wolitzky, K., Fivush, R., Zimand, E., Hodges, L., & Rothbaum, B. O. (2005). Effectiveness of virtual reality distraction during a painful medical procedure in pediatric oncology patients. Psychology & Health, 20(6), 817–824. https://doi.org/10.1080/14768320500143339

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