Multi-modal distraction. Using technology to combat pain in young children with burn injuries

Background: The use of non-pharmacological pain management remains adhoc within acute paediatric burns pain management protocols despite ongoing acknowledgement of its role. Advancements in adult based pain services including the integration of virtual reality has been adapted to meet the needs of children in pain, as exemplified by the development of multi-modal distraction (MMD). This easy to use, hand held interactive device uses customised programs designed to inform the child about the procedure he/she is about to experience and to distract the child during dressing changes. Aim: (1) To investigate if either MMD procedural preparation (MMD-PP) or distraction (MMD-D) has a greater impact on child pain reduction compared to standard distraction (SD) or hand held video game distraction (VG), (2) to understand the impact of MMD-PP and MMD-D on clinic efficiency by measuring length of treatment across groups, and lastly, (3) to assess the efficacy of distraction techniques over three dressing change procedures. Methods: A prospective randomised control trial was completed in a paediatric tertiary hospital Burns Outpatient Clinic. Eighty participants were recruited and studied over their first three dressing changes. Pain was assessed using validated child report, caregiver report, nursing observation and physiological measures. Results: MMD-D and MMD-PP were both shown to significantly relieve reported pain (p <= 0.05) and reduce the time taken for dressings (p <= 0.05) compared to SD and VG. The positive effects of both MMD-D and MMD-PP were sustained with subsequent dressing changes. Conclusions: The use of MMD as a preparatory or a distraction tool in an outpatient burns clinic offered superior pain reduction across three dressing changes to children when compared to standard practices or hand held video games. This device has the potential to improve clinic efficiency with reductions in treatment lengths. (C) 2009 Elsevier Ltd and ISBI. All rights reserved.