Age and Sex Differences of Virtual Reality Pain Alleviation Therapeutic During Pediatric Burn Care: A Randomized Clinical Trial

Virtual reality (VR) effectively alleviates pain for pediatric patients during many medical care procedures, such as venipuncture and burn wound care. Whether VR pain alleviation therapeutics (VR-PAT) differ by a patients age or sex remains unresolved. This randomized clinical trial evaluated how age and sex affect VR pain alleviation during dressing care for pediatric burns. Ninety patients aged 6 to 17 years (inclusive) with burn injuries were recruited from an outpatient burn clinic of an American Burn Association verified pediatric burn center. Before randomization, expectations of VR helpfulness and need were assessed on a visual analog scale (VAS, 0 to 100). Participants were randomly assigned to active or passive VR for one burn dressing change. Immediately following the dressing change, participants self reported pain and the time spent thinking about pain and rated the VR features on the degrees of realism experienced, pleasure/fun, and perceived engagement level. Path analyses assessed how these VR features were interrelated and how they affected self-reported pain by age and sex. Patients aged 6 to 9 years reported higher mean expectations of VR helpfulness and need (mean=73.6 and 94.5, respectively) than 10 to 12 year olds (mean=55.7 and 84.2, respectively) and 13 to 17 year olds (mean=68.6 and 77.4, respectively). The path analysis indicated VR engagement and fun were significantly correlated (p value <0.05). VR engagement significantly negatively impacted overall pain scores during burn dressing (coefficient=-0.45, -0.41; p value <0.05) and significantly positively impacted time thinking of pain (coefficient=0.38, 0.32; p value <0.05). Younger patients had the highest expectations of VR pain alleviation helpfulness and need. VR game realism, fun, and engagement features were not statistically different between age groups and sexes. VR engagement and thinking of pain during burn dressing significantly positively affected self-reported pain (p value <0.05), suggesting an analgesic mechanism beyond distraction alone. Younger patients benefited more from VR pain alleviation therapeutics than older patients.