Mobile Phone Virtual Reality Game for Pediatric Home Burn Dressing Pain Management, a Randomized Clinical Trial

Importance: Virtual Reality (VR) gaming is considered a safe and effective alternative to standard pain alleviation in the hospital, we advocate for its use during repeated redressing at home. Objective: This study will address the effectiveness and feasibility of the Virtual Reality Pain Alleviation Tool (VR-PAT) that was developed by the research team for repeated at-home burn dressing changes. Design, Setting and Participants: Randomized clinical trial among patients recruited at the Nationwide Childrens Hospital (NCH) outpatient burn clinic between September 2019 and June 2021. We included English-speaking burn patients 5-17 years old requiring daily dressing changes for at least one week after first outpatient dressing change. Interventions: One group played an interactive VR-PAT game during dressing changes, while the other utilized standard distraction techniques available in the home for a week. Both child and caretaker were later asked to assess perceived pain. Those in the intervention group were asked to evaluate convenience and enjoyment of the VR-PAT game. Outcomes: Patients were asked to rate perceived pain on a scale of 1-10, and caregivers were asked to rate observed pain on a scale of 1-10. For the VR-PAT group, patients were also asked to rate various aspects of the VR game on a scale of 1-10 and caregivers were asked questions assessing ease of use. Conclusions: Subjects found the VR-PAT to be a useful distraction during home dressing changes and reported it be easy to implement. In the VR-PAT group, child and caregiver reported pain decreased as the week of dressing changes progressed and was lower than those in the control group after the fourth dressing change. Children playing the VR-PAT reported consistent happiness and fun as the week went on and increased realism and engagement, which means our results were not just due to the novel experience of VR-PAT.

Low-Dose Fentanyl Reduces Pain Perception, Muscle Sympathetic Nerve Activity Responses, and Blood Pressure Responses During the Cold Pressor Test

Our knowledge about how low-dose (analgesic) fentanyl affects autonomic cardiovascular regulation is primarily limited to animal experiments. Notably, it is unknown if low-dose fentanyl influences human autonomic cardiovascular responses during painful stimuli in humans. Therefore, we tested the hypothesis that low-dose fentanyl reduces perceived pain and subsequent sympathetic and cardiovascular responses in humans during an experimental noxious stimulus. Twenty-three adults (10F/13M; 27±7 y; 26±3 kg•m-2, mean ± SD) completed this randomized, crossover, placebo-controlled trial during two laboratory visits. During each visit, participants completed a cold pressor test (CPT; hand in ~0.4 °C ice bath for two minutes) before and five minutes after drug/placebo administration (75 μg fentanyl or saline). We compared pain perception (100 mm visual analog scale), muscle sympathetic nerve activity (MSNA; microneurography, 11 paired recordings), and beat-to-beat blood pressure (BP; photoplethysmography) between trials (at both pre- and post-drug/placebo time points) using paired, two-tailed t-tests. Before drug/placebo administration, perceived pain (p=0.8287), Δ MSNA burst frequency (p=0.7587), and Δ mean BP (p=0.8649) during the CPT were not different between trials. After the drug/placebo administration, fentanyl attenuated perceived pain (36 vs. 66 mm, p<0.0001), Δ MSNA burst frequency (9 vs. 17 bursts/minute, p=0.0054), and Δ mean BP (7 vs. 13 mmHg, p=0.0174) during the CPT compared to placebo. Fentanyl-induced reductions in pain perception and Δ mean BP were moderately related (r=0.40, p=0.0641). These data provide valuable information regarding how low-dose fentanyl reduces autonomic cardiovascular responses during an experimental painful stimulus.

Linguistic Validation of the Canine Brief Pain Inventory (CBPI) for Global Use

A valid and reliable quantitative measure of chronic pain is essential for developing and evaluating interventions that aim to treat pain. In dogs, the Canine Brief Pain Inventory (CBPI) was originally adapted from a human measure, the Brief Pain Inventory, to assess owner-perceived pain and the impact of such pain on a dog's daily functioning. To be reliable and valid, data collected using a translated instrument should have evidence it is an accurate representation of the original instrument and is culturally appropriate for use in the intended context. To achieve this, instruments should undergo a rigorous translation process and be debriefed in the intended population of use. The CBPI is widely accepted and has been fully validated for use in US-English, Swedish, Italian, and French (France); further translation and validation of the CBPI is required to increase access to and use in other languages and countries. The objective of this study was to linguistically validate the CBPI for global use (Australia, China, Germany, Hungary, Ireland, Japan, Netherlands and Portugal). In cognitive debriefing with a representative sample of dog owners in the target countries it was confirmed that the translations of the CBPI adequately convey the concepts in the original US-English version and that items are easily understood by dog owners. The results of the linguistic validation process thus produced measures that are conceptually equivalent to the original US-English-language CBPI and are culturally appropriate for use in the target countries.

Detection of Changes on Parameters Related to Heart Rate Variability after Applying Current Interferential Therapy in Subjects with Non-Specific Low Back Pain

Interferential current therapy (ICT) is an electrotherapeutic intervention that combines the advantages of high permeability from middle frequency currents and efficient tissue stimulation from low frequency currents, delivering the maximum current with high tissue permeability. The aim was to evaluate the effects of ICT on heart rate variability (HRV) and on pain perception in patients with non-specific chronic low back pain (NSCLBP). In the study, 49 patients with NSCLBP were randomly divided into an experimental (EG) and a sham group (SG). All participants received a single intervention, ICT, or simulated intervention. Outcome measures including baseline (sit-down position) and postintervention (prone position) pain, heart rate (HR), time domain parameter (rMSSD), diameters of the Poincaré plot (SD1, SD2), stress score (SS), and sympathetic/parasympathetic (S/PS) ratio were investigated. In both groups, significant statistical differences were found in perceived pain and in all HRV parameters except in HRmax. Between-group comparisons showed statistically significant differences in all variables except for HRmin and HRmean in favor of the experimental group. These changes reported an increase in parasympathetic activity (rMSSD) (p < 0.05) and a decrease in sympathetic activity (increase in SD2 and decrease in SS) (p < 0.001) and perceived pain (p < 0.001), with a greater size effect (η2 = 0.44) in favor of the experimental group. In conclusion, a single session of ICT can shift the autonomic balance towards increase parasympathetic dominance and decrease the sympathetic dominance and intensity of pain perceived by patients with NSCLBP.

The Impact of Quarantine on Emotions during the COVID-19 Pandemic

Introduction: The present study explores how the general population of Lithuania felt during the national quarantine of COVID-19 in the period from March 30th to June 8th, 2020. Representative subjects were interviewed five times using adapted single-item questions to evaluate their emotions, stress, and perceived pain levels. Methods: It was hypothesized that gender and age-related differences would be found in emotional responses to the quarantine. Results and Discussion: During the five polls taken, more women were found to report feeling stressed, anxious, sad, and in more physical pain than men. Evaluations of anger, enjoyment, and calmness provided no statistically significant gender differences. Emotions were found to differ significantly between three age groups (18-29, 30-49, 50-74). Conclusion: Contrary to expectations, the biggest negative impact of quarantine was found in the youngest group aged 18-29 years: it showed the highest prevalence of stress, anxiety, and sadness of all age groups. Possible explanations for different gender and age-related emotional reactions are discussed.

The Relationship Between Dysmenorrhoea and Student Learning Activities at High School 3 Palembang

Dysmenorrhea is a menstrual disorder often faced by adolescent girls. In some people with dysmenorrhoea, perceived pain can interfere with daily physical activity giving the impact on quality of life and productivity of students in the school. This study aims to determine the relationship between dysmenorrhea and learning activities at SMA Negeri 3 Palembang. This study was an analytic observational study with cross sectional design conducted in November-Desember 2015. The population in this study were all students of SMA Negeri 3 Palembang. The samples were obtained by total sampling with total sample of 631 female student. Data were obtained through a questionnaire given to respondents. The results were analyzed by using Fisher's Exact Test. From this study, the prevalence of students who suffer from dysmenorrhea was 91.3%. Number of respondent with dysmenorrhea and disturbed study activity was 56.4%. Results of bivariat analysis showed a highly significant relationship between dysmenorrhea and study activity (p=0.000).

Effectiveness of Two Different Methods on the Perceived Pain and Satisfaction During Intramuscular Antibiotic Injection: ShotBlocker and Local Vibration

In this study aimed to examine the effectiveness of ShotBlocker and local vibration on the perceived pain and satisfaction during intramuscular antibiotic injection. The sample of the randomized controlled experimental study consisted of 100 patients (32 in vibration group, 35 in ShotBlocker group, 33 in control group) who applied to the adult emergency clinic for antibiotic (amoxicillin/cefuroxime sodium) injection between April and May 2021. The study data were collected using the Structured Information Form, VAS for Pain and VAS for Satisfaction. CONSORT statement was followed for reporting. After the intramuscular antibiotic injection, a significant difference was found between the groups in terms of the mean scores of VAS for Pain and VAS for Injection Satisfaction ( p < .001). It was determined that local vibration application was more effective in reducing the pain and in increasing satisfaction that occurs during intramuscular antibiotic injection according to ShotBlocker and control groups.