The Association Between Pain Relief Using Video Games and an Increase in Vagal Tone in Children With Cancer: Analytic Observational Study With a Quasi-Experimental Pre/Posttest Methodology

Mario Alonso Puig, Mercedes Alonso-Prieto, Jordi Miró, Raquel Torres-Luna, Diego Plaza López de Sabando, Francisco Reinoso-Barbero, Mario Alonso Puig, Mercedes Alonso-Prieto, Jordi Miró, Raquel Torres-Luna, Diego Plaza López de Sabando, Francisco Reinoso-Barbero

Abstract

Background: Patients with secondary pain due to mucositis after chemotherapy require treatment with morphine. Use of electronic video games (EVGs) has been shown to be an effective method of analgesia in other clinical settings.

Objective: The main objective of this study was to assess the association between the use of EVGs and the intensity of pain caused by chemotherapy-induced mucositis in pediatric patients with cancer. The secondary objective was to assess the association between changes in pain intensity and sympathetic-parasympathetic balance in this sample of pediatric patients.

Methods: Clinical records were compared between the day prior to the use of EVGs and the day after the use of EVGs. The variables were variations in pupil size measured using the AlgiScan video pupilometer (IDMed, Marseille, France), heart rate variability measured using the Analgesia Nociception Index (ANI) monitor (Mdoloris Medical Systems, Loos, France), intensity of pain measured using the Numerical Rating Scale (score 0-10), and self-administered morphine pump parameters.

Results: Twenty patients (11 girls and nine boys; mean age 11.5 years, SD 4.5 years; mean weight 41.5 kg, SD 20.7 kg) who met all the inclusion criteria were recruited. EVGs were played for a mean of 2.3 (SD 1.3) hours per day, resulting in statistically significant changes. After playing EVGs, there was significantly lower daily morphine use (before vs after playing EVGs: 35.9 vs 28.6 µg/kg/day, P=.003), lower demand for additional pain relief medication (17 vs 9.6 boluses in 24 hours, P=.001), lower scores of incidental pain intensity (7.7 vs 5.4, P=.001), lower scores of resting pain (4.8 vs 3.2, P=.01), and higher basal parasympathetic tone as measured using the ANI monitor (61.8 vs 71.9, P=.009). No variation in pupil size was observed with the use of EVGs.

Conclusions: The use of EVGs in pediatric patients with chemotherapy-induced mucositis has a considerable analgesic effect, which is associated physiologically with an increase in parasympathetic vagal tone despite lower consumption of morphine.

Keywords: acute pain; analgesia nociception index; hematology oncology; patient-controlled analgesia; pediatric patient; video pupilometer.

Conflict of interest statement

Conflicts of Interest: None declared.

©Mercedes Alonso-Prieto, Jordi Miró, Raquel Torres-Luna, Diego Plaza López de Sabando, Francisco Reinoso-Barbero. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.03.2020.

Figures

Figure 1
Figure 1
Child playing an electronic video game while being fitted with a patient-controlled analgesia pump and monitored for respiratory heart rate variability.
Figure 2
Figure 2
Distribution of hours of playing video games with the maximum variation in incidental pain with and without the use of video games in each patient.
Figure 3
Figure 3
Variations in basal daily pain with and without the use of video games in each patient.

References

    1. Bouya S, Balouchi A, Maleknejad A, Koochakzai M, AlKhasawneh E, Abdollahimohammad A. Cancer Pain Management Among Oncology Nurses: Knowledge, Attitude, Related Factors, and Clinical Recommendations: a Systematic Review. J Cancer Educ. 2019 Oct;34(5):839–846. doi: 10.1007/s13187-018-1433-6.
    1. Donohoe C, Bosi JK, Sykes A, Lu Z, Mandrell B. Clinical Characteristics of Children and Adolescents Undergoing Hematopoietic Cell Transplantation Who Develop Oral Mucositis. Oncol Nurs Forum. 2018 Jul 02;45(4):457–462. doi: 10.1188/18.ONF.457-462.
    1. Mertens R. [Pain therapy in pediatric oncology: pain experience, drugs and pharmacokinetics] Anasthesiol Intensivmed Notfallmed Schmerzther. 2011 Nov;46(11-12):736–42. doi: 10.1055/s-0031-1297180.
    1. Subramaniam SD, Doss B, Chanderasekar LD, Madhavan A, Rosary AM. Scope of physiological and behavioural pain assessment techniques in children - a review. Healthc Technol Lett. 2018 Aug;5(4):124–129. doi: 10.1049/htl.2017.0108.
    1. Collins JJ, Geake J, Grier HE, Houck CS, Thaler HT, Weinstein HJ, Twum-Danso NY, Berde CB. Patient-controlled analgesia for mucositis pain in children: a three-period crossover study comparing morphine and hydromorphone. J Pediatr. 1996 Nov;129(5):722–8. doi: 10.1016/s0022-3476(96)70156-7.
    1. Nelson KL, Yaster M, Kost-Byerly S, Monitto CL. A national survey of American Pediatric Anesthesiologists: patient-controlled analgesia and other intravenous opioid therapies in pediatric acute pain management. Anesth Analg. 2010 Mar 01;110(3):754–60. doi: 10.1213/ANE.0b013e3181ca749c.
    1. Inan G, Inal S. The Impact of 3 Different Distraction Techniques on the Pain and Anxiety Levels of Children During Venipuncture: A Clinical Trial. Clin J Pain. 2019 Feb;35(2):140–147. doi: 10.1097/AJP.0000000000000666.
    1. Primack BA, Carroll MV, McNamara M, Klem ML, King B, Rich M, Chan CW, Nayak S. Role of video games in improving health-related outcomes: a systematic review. Am J Prev Med. 2012 Jun;42(6):630–8. doi: 10.1016/j.amepre.2012.02.023.
    1. Law EF, Dahlquist LM, Sil S, Weiss KE, Herbert LJ, Wohlheiter K, Horn SB. Videogame distraction using virtual reality technology for children experiencing cold pressor pain: the role of cognitive processing. J Pediatr Psychol. 2011 Jan;36(1):84–94. doi: 10.1093/jpepsy/jsq063.
    1. Das DA, Grimmer KA, Sparnon AL, McRae SE, Thomas BH. The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: a randomized controlled trial [ISRCTN87413556] BMC Pediatr. 2005 Mar 03;5(1):1. doi: 10.1186/1471-2431-5-1.
    1. Sánchez-Rodríguez E, Miró J, Castarlenas E. A comparison of four self-report scales of pain intensity in 6- to 8-year-old children. Pain. 2012 Aug;153(8):1715–9. doi: 10.1016/j.pain.2012.05.007.
    1. Ledowski T. Objective monitoring of nociception: a review of current commercial solutions. Br J Anaesth. 2019 Aug;123(2):e312–e321. doi: 10.1016/j.bja.2019.03.024.
    1. White MC, Hommers C, Parry S, Stoddart PA. Pain management in 100 episodes of severe mucositis in children. Paediatr Anaesth. 2011 Apr;21(4):411–6. doi: 10.1111/j.1460-9592.2010.03515.x.
    1. Primack BA, Carroll MV, McNamara M, Klem ML, King B, Rich M, Chan CW, Nayak S. Role of video games in improving health-related outcomes: a systematic review. Am J Prev Med. 2012 Jun;42(6):630–8. doi: 10.1016/j.amepre.2012.02.023.
    1. Culbert T. Perspectives on Technology-Assisted Relaxation Approaches to Support Mind-Body Skills Practice in Children and Teens: Clinical Experience and Commentary. Children (Basel) 2017 Apr 04;4(4) doi: 10.3390/children4040020.
    1. Arman N, Tarakci E, Tarakci D, Kasapcopur O. Effects of Video Games-Based Task-Oriented Activity Training (Xbox 360 Kinect) on Activity Performance and Participation in Patients With Juvenile Idiopathic Arthritis: A Randomized Clinical Trial. Am J Phys Med Rehabil. 2019 Mar;98(3):174–181. doi: 10.1097/PHM.0000000000001001.
    1. Hua Y, Qiu R, Yao W, Zhang Q, Chen X. The Effect of Virtual Reality Distraction on Pain Relief During Dressing Changes in Children with Chronic Wounds on Lower Limbs. Pain Manag Nurs. 2015 Oct;16(5):685–91. doi: 10.1016/j.pmn.2015.03.001.
    1. Sekiguchi T, Hagiwara Y, Yabe Y, Tsuchiya M, Itaya N, Yoshida S, Yano T, Sogi Y, Suzuki K, Itoi E. Playing video games for more than 3 hours a day is associated with shoulder and elbow pain in elite young male baseball players. J Shoulder Elbow Surg. 2018 Sep;27(9):1629–1635. doi: 10.1016/j.jse.2018.06.005.
    1. Kauhanen L, Järvelä L, Lähteenmäki PM, Arola M, Heinonen OJ, Axelin A, Lilius J, Vahlberg T, Salanterä S. Active video games to promote physical activity in children with cancer: a randomized clinical trial with follow-up. BMC Pediatr. 2014 Apr 05;14:94. doi: 10.1186/1471-2431-14-94.
    1. Windich-Biermeier A, Sjoberg I, Dale JC, Eshelman D, Guzzetta CE. Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer. J Pediatr Oncol Nurs. 2007;24(1):8–19. doi: 10.1177/1043454206296018.
    1. Julien-Marsollier F, Rachdi K, Caballero M, Ayanmanesh F, Vacher T, Horlin A, Skhiri A, Brasher C, Michelet D, Dahmani S. Evaluation of the analgesia nociception index for monitoring intraoperative analgesia in children. Br J Anaesth. 2018 Aug;121(2):462–468. doi: 10.1016/j.bja.2018.03.034.
    1. Migeon A, Desgranges F, Chassard D, Blaise BJ, De Queiroz M, Stewart A, Cejka J, Combet S, Rhondali O. Pupillary reflex dilatation and analgesia nociception index monitoring to assess the effectiveness of regional anesthesia in children anesthetised with sevoflurane. Paediatr Anaesth. 2013 Dec;23(12):1160–5. doi: 10.1111/pan.12243.
    1. Kumar A, Das S, Chauhan S, Kiran U, Satapathy S. Perioperative Anxiety and Stress in Children Undergoing Congenital Cardiac Surgery and Their Parents: Effect of Brief Intervention-A Randomized Control Trial. J Cardiothorac Vasc Anesth. 2019 May;33(5):1244–1250. doi: 10.1053/j.jvca.2018.08.187.
    1. Nelson SM, Cunningham NR, Kashikar-Zuck S. A Conceptual Framework for Understanding the Role of Adverse Childhood Experiences in Pediatric Chronic Pain. Clin J Pain. 2017 Mar;33(3):264–270. doi: 10.1097/AJP.0000000000000397.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir