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Extended Reality (XR) in Pediatric Acute and Chronic Pain: Systematic Review and Evidence Gap Map
Courtney W Hess1, Brittany N Rosenbloom2,3, Giulia Mesaroli4,5,6
1Department of Anesthesiology, Perioperative, & Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.
JMIR Pediatrics and Parenting
|April 7, 2025
Summary
Extended reality (XR) shows promise for pediatric acute pain management, with most studies focusing on virtual reality (VR). More research is needed for chronic pain and to address bias in current studies.
Area of Science:
- Pain Management
- Biobehavioral Interventions
- Extended Reality (XR)
Background:
- Extended reality (XR), encompassing virtual reality (VR) and augmented reality (AR), has emerged as a significant biobehavioral intervention for pain management over the past decade.
- Existing literature on XR for adult pain indicates positive outcomes, particularly for acute procedural pain.
Purpose of the Study:
- To systematically review the evidence on the feasibility, safety, and effectiveness of XR for pediatric acute and chronic pain.
- To identify assessment tools used for study outcomes and pinpoint evidence gaps for future research directions.
Main Methods:
- A systematic literature review was conducted, searching multiple databases (CINAHL, Cochrane Central, Embase, MEDLINE, PsycINFO) up to March 2023.
- Included studies involved participants aged 0-18 years, utilized VR or AR interventions, and reported outcomes related to pain, safety, feasibility, or acceptability.
- Data extraction focused on study and XR characteristics, outcome measures, and findings on safety, feasibility, and effectiveness.
Main Results:
- Ninety articles were included, all using VR, with 93% focusing on acute pain.
- Safety was generally positive, with most adverse events reported as low concern. Feasibility was assessed in 27 studies.
- Positive effects on pain intensity were reported in 62% of acute pain studies and all chronic pain studies. A moderate to high risk of bias was noted in 84 out of 90 studies.
Conclusions:
- XR, primarily VR, demonstrates safety and effectiveness for pediatric acute pain intensity.
- Evidence for XR in pediatric chronic pain is limited, necessitating further investigation.
- High risk of bias in existing studies highlights the need for improved research methodologies, including consistent outcome measurement and addressing blinding challenges.
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