80 Distraction in the ED using Virtual reality for Intravenous Needs in Children to Improve comfort -the DEVINCI project: A Pilot RCT

Background Venipuncture is a frequent cause of pain and distress in the pediatric emergency department (ED). Healthcare professionals must optimize patient comfort during such procedures, given the associated short- and long-term adverse events. Distraction, which can improve patient experience, remains the most studied psychological intervention. Virtual reality (VR) is a method of immersive distraction that can contribute to the multi-modal management of procedural pain and distress. Its use in the healthcare setting has become more accessible due to the development of more portable and affordable systems. Objectives The primary outcome of this study was to determine the feasibility and acceptability of a VR distraction device in the pediatric ED. The secondary outcomes were to examine the preliminary effects of the addition of VR to standard practice on children’s pain, distress, and memory of pain associated with venipunctures in the pediatric ED. Design/Methods This pilot RCT was performed at a tertiary pediatric centre. Children 7-17 years old requiring a venipuncture in the ED were recruited. Participants were randomized to either a control group (standard care) or intervention group (standard care+VR). A priori feasibility and acceptability criteria were established following expert consensus (nurses/physicians working in the ED): - 80% of families approached for recruitment consent to participate; - 80% of recruited patients finish the game as planned (intervention group); - Mean >7 on the 0-10 satisfaction scale (patients/parents/healthcare providers); - No serious adverse events. The principal clinical outcome was the mean level of procedural pain as measured by the verbal numerical rating scale (VNRS). Auto-evaluation of procedural-related distress was performed using the Child Fear Scale (CFS). The level of distress related to the procedure was also evaluated by proxy using the Procedure Behavior Check List (PBCL). Memory of pain was measured at 24h using the VNRS. Side effects were documented. Results A total of 63 patients were recruited between December 2018 and April 2019 (one was excluded as the venipuncture was later cancelled). The results showed feasibility and acceptability of VR in the pediatric ED with: -79% recruitment rate of eligible families -90% rate of VR game completion as per protocol (reason for not completing the game: prior headache, wanting to see, VR not working well) and -overall high mean satisfaction levels. In addition, there was a significantly higher level of satisfaction among healthcare providers in the intervention group, and 93% of those were willing to use this technology again for the same procedure. Regarding clinical outcomes, there was no significant difference between groups in self-reported procedural pain, but evaluation of distress by proxy (10/40 vs 13.2/40, p = 0.007) and memory of pain at 24 hours (2.4 vs 4.2, p = 0.027) were significantly lower in the intervention group. Venipuncture was successful on first attempt in 23/31 patients (74%) in the VR group and 15/30 (50%) patients in the control group (p = 0.039). Five of the 31 patients (16%) in the VR group reported side effects, which were mild and self-resolving. Conclusion The addition of VR to standard of care for pain and distress management related to venipunctures in the pediatric ED is a feasible and acceptable intervention. Side effects related to VR were few and self-resolving. Both experimental groups were similar with respect to self-reported procedural pain. A lower level of procedural distress, lower memory of pain at 24 hours, and higher venipuncture first attempt success rate were observed in the VR group.

Neuroimaging investigation of memory changes in migraine: a systematic review

ABSTRACT Background: Individuals with migraine usually complain about lower memory performance. Diagnostic methods such as neuroimaging may help in the understanding of possible morphologic and functional changes related to the memory of those individuals. Therefore, the aim of this review is to analyze the available literature on neuroimaging changes related to memory processing in migraine. Methods: We searched the following databases: Pubmed/Medline, Psycinfo, Science Direct, Cochrane and Web of Science. We used articles without restriction of year of publication. The combination of descriptors used for this systematic review of literature were Neuroimaging OR Imaging OR Brain AND Migraine OR Chronic Migraine AND Memory. Results: Of the 306 articles found, nine were selected and all used magnetic resonance imaging (MRI). The studies used structural and functional MRI techniques with a predominance of 3 Tesla equipment and T1-weighted images. According to the results obtained reported by these studies, migraine would alter the activity of memory-related structures, such as the hippocampus, insula and frontal, parietal and temporal cortices, thereby suggesting a possible mechanism by which migraine would influence memory, especially in relation to the memory of pain. Conclusions: Migraine is associated to global dysfunction of multisensory integration and memory processing. This condition changes the activity of structures in various regions related to memory of pain, prospective memory, as well as in short- and long-term verbal and visuospatial memories. However, it is necessary to perform studies with larger samples in association with cognitive tests, and without the interference of medications to verify possible alterations and to draw more concrete conclusions.

LO52: Distraction in the ED using Virtual reality for Intravenous Needs in Children to Improve comfort- DEVINCI - a pilot RCT

Introduction: Venipuncture is a frequent cause of pain and distress in the pediatric emergency department (ED). Distraction, which can improve patient experience, remains the most studied psychological intervention. Virtual reality (VR) is a method of immersive distraction that can contribute to the multi-modal management of procedural pain and distress. Methods: The main objectives of this study were to determine the feasibility and acceptability of Virtual Reality (VR) distraction for pain management associated with venipunctures and to examine its preliminary effects on pain and distress in the pediatric ED. Children 7-17 years requiring a venipuncture in the pediatric ED were recruited. Participants were randomized to either a control group (standard care) or intervention group (standard of care + VR). Principal clinical outcome was the mean level of procedural pain, measured by the verbal numerical rating scale (VNRS). Distress was also measured using the Child Fear Scale (CFS) and the Procedure Behavior Check List (PBCL) and memory of pain using the VNRS. Side effects were documented. Results: A total of 63 patients were recruited. Results showed feasibility and acceptability of VR in the PED and overall high satisfaction levels (79% recruitment rate of eligible families, 90% rate of VR game completion, and overall high mean satisfaction levels). There was a significantly higher level of satisfaction among healthcare providers in the intervention group, and 93% of those were willing to use this technology again for the same procedure. Regarding clinical outcomes, no significant difference was observed between groups on procedural pain. Distress evaluated by proxy (10/40 vs 13.2/40, p = 0.007) and memory of pain at 24 hours (2.4 vs 4.2, p = 0.027) were significantly lower in the VR group. Venipuncture was successful on first attempt in 23/31 patients (74%) in the VR group and 15/30 (50%) patients in the control group (p = 0.039). Five of the 31 patients (16%) in the VR group reported side effects Conclusion: The addition of VR to standard care is feasible and acceptable for pain and distress management during venipunctures in the pediatric ED. There was no difference in self-reported procedural pain between groups. Levels of procedural distress and memory of pain at 24 hours were lower in the VR group.

Sewing Pain: Using Costume To Bring The Clinical Body Forward

This article looks at how memory of pain and physical change provoked by surgery can be translated into costume design (understood as an extension of the performer’s body in action). My main question is in what way the construction of a performer’s secondary skin—bringing her wounds outward and forward through the sculpting of fabric into form, texture and color—can mediate between performer and spectator and shape her extended body. By making the performer’s embodied knowledge visible through costume, costume is used to enlarge her capacity for expression. Gesture and movement are central to a costume designer’s creative process. In the case of Anticorpos we were working also with actress Isabel Craveiro’s personal memories of body change. It was crucial that the design incorporated the performer’s verbal and sensual account of the multiple surgeries she had been subjected to over the course of 4 years. As she made these visible through action, I used them to inform the costume design which in turn allowed her to choose what to show and when. Fabric would at times constrain her body into a new shape, at other times expand her gestures.

Body Memory of Pain and Trauma

At first sight, pain seems to be an unhistorical phenomenon: in its intrusive nagging presence, nothing refers to the past, and to remember one’s pain is only possible in an abstract sense. However, one’s individual sensitivity as well as one’s relation to pain are shaped biographically, even though we usually are not aware of this: pains are inscribed into body memory and thus unfold a lasting impact. The memory of the subject may thus also be conceived as a history of painful confrontations with the world, in the course of which the borders of self and non-self are constituted and accentuated. These interrelations are the topic of the paper.