Cutaneous burn injuries result in prolonged anatomic, physiologic, and psychologic morbidity in patients of all ages,. Physiologic and psychologic morbidity are particularly problematic in children, in large part due to the necessity for recurrent (daily) painful procedures -- including burn wound care and rehabilitation therapy -- at the hands of health care providers, and the relative challenge (compared to adults) of providing safe and satisfactory pharmacologic analgesia. Clinical burn pain management in children is challenging, with current research efforts largely focused on the pharmacologic management of background and wound care pain in acutely injured and hospitalized children. This project, however, investigates a novel cognitive/distractive analgesic technique -- virtual reality (VR) in two common and equally challenging, yet relatively unstudied settings: postburn rehabilitation therapy and outpatient burn wound care. Because of the frequent need for long-term care in these two settings, improved analgesic management carries the potential for significant improvements in patient compliance, functional wound healing, and psychologic morbidity, as well as the potential economic benefit of earlier hospital discharge. The goals of this project are: 1) to determine the appropriate design of virtual reality hardware and software for video technology-hungry school-aged and adolescent (ages 8-18 years) burn victims whose injuries require painful rehabilitation therapy or outpatient wound care; and 2) to determine the degree to which virtual reality, as a non-invasive, non- pharmacologic analgesic technique, can supplement or possibly replace more invasive pharmacologic analgesic techniques in this population. The anticipated benefits of this pilot project include the development of activity-specific and age-appropriate virtual reality hardware and software that can facilitate analgesic management in this challenging patient population, as well as important preliminary data on the analgesic efficacy of virtual reality for use in designing more focused study protocols in subsequent investigations. Finally, because burn injuries offer a paradigm for the management of acute pain in general, the results of these investigations will likely be generalizable to other causes of acute and rehabilitation pain, and to other burn patient populations, including adults and young children.
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