Guided Relaxation-Based Virtual Reality Transiently Reduces Acute Postoperative Pain and Anxiety in a Pediatric Population
Authors: Olbrecht Vanessa A. , O’Conor Keith T. , Williams Sara E. , Boehmer Chloe O. , Marchant Gilbert W. , Glynn Susan M. , Geisler Kristie J. , Ding Lili , Yang Gang , King Christopher D. 
Published: September 2020

AbstractBackgroundVirtual reality (VR)-based immersive games and content can distract or redirect attention. Distraction-based therapies, such as VR, have been used to reduce pain from acutely painful procedures. However, it is unlikely that distraction alone can produce the prolonged pain reduction required to manage sustained postoperative pain. Integration of VR with other pain reducing therapies, including mind-body techniques, may enhance their clinical impact. Slow breathing and relaxation techniques are used clinically to reduce pain in children. Incorporating techniques such as these into the immersive audio-visual VR experience has the potential to produce synergistic effects. The current pilot study assessed the ability of a single guided relaxation-based VR (VR-GR) session to decrease acute postoperative pain and anxiety in children and adolescents. We also explored whether pain catastrophizing and anxiety sensitivity influenced the ability of VR-GR to reduce these outcomes.MethodsA total of 51 children and adolescents (ages 7-21 years) with postoperative pain followed by the Acute Pain Service at Cincinnati Children’s Hospital Medical Center were recruited over an 8-month period to undergo a single VR-GR session. Prior to VR, patients completed pain catastrophizing (PCS-C) and anxiety sensitivity (CASI) questionnaires. The primary outcome was changes in pain intensity following VR-GR (immediately, 15, and 30 minutes). Secondary outcomes included changes in pain unpleasantness and anxiety.ResultsBased on mixed effects models, VR-GR decreased pain intensity immediately (p < 0.001) and 30 minutes (p = 0.04) after the VR session, but not at 15 minutes (p = 0.16) postsession. Reductions in pain unpleasantness were observed during all time intervals (p < 0.001 at all intervals). Anxiety was reduced immediately (p = 0.02) but not at 15- (p = 0.08) or 30- (p = 0.30) minutes following VR-GR. Adjustment for covariates showed that patients with higher CASI reported greater reductions in pain intensity (p = 0.04) and unpleasantness (p = 0.01) following VR-GR. Pain catastrophizing did not impact changes in pain and anxiety following the VR session (all p’s > 0.10).ConclusionA single, short VR-GR session produced immediate and acute reductions in pain intensity, pain unpleasantness, and anxiety in children and adolescents with acute postoperative pain. These results encourage future randomized clinical trials to compare the effectiveness of VR-GR and mind-body based treatments to reduce postoperative pain outcomes and to reduce requirements for opioid medications during this period.Key Points SummaryQuestionCan guided relaxation-based VR transiently reduce pain and anxiety in children and adolescents following surgery?FindingsA single session of guided relaxation-based VR transiently reduces pain intensity, pain unpleasantness, and anxiety in children and adolescents with severe, acute postoperative pain.MeaningGuided relaxation-based VR offers an innovative, nonpharmacologic strategy to help manage pain and anxiety in children and adolescents after surgery and combining traditional mind-body therapies with the immersive nature of VR opens new possibilities for multimodal analgesia.