One of the most frequent, yet challenging secondary problems experienced by children who require rehabilitation from disabling conditions is pain. Pain occurs at rest and/or with rehabilitation activities and arises in both chronic settings (e.g., cerebral palsy) and subacute settings (e.g., repetitive wound care and physical therapy during extended treatment of cutaneous burns). Conventional pharmacologic analgesic strategies, although widely used and efficacious in children with acute pain, are avoided in these chronic and subacute settings due to associated complication (e.g. tolerance) and lack of efficacy (development of central neuropathic pain syndromes). This project will explore two non-pharmacologic analgesic techniques for children ages 8-20 years, emphasizing 1) virtual reality (VR) analgesia, a highly innovative technology with newly demonstrated efficacy in such settings, and 2) its novel combination with hypnosis. The analgesic mechanisms of VR and hypnosis are incompletely understood, although they share a common thread distraction of conscious attention from environmental stimuli, leaving less of this cognitive resource to devote to pain perception. The goal of this project is to develop a program that will effectively investigate the analgesic mechanisms and optimize the clinical use of VR and combined VR/hypnosis in disabled children with pain and/or who require rehabilitation activities.
The specific aims of the project are 1) to develop an effective, multidisciplinary group capable of posing and answering appropriate study questions with tangible outcome measures, 2) to design and fabricate VR hardware ad software, and develop VR protocols necessary to address mechanistic questions and perform future clinical trials, and 3) to perform pilot clinical studies to assess the efficacy of repetitive application of VR, and to investigate the efficacy of and the interactions between VR and hypnosis when used simultaneously. The anticipated immediate benefits of this project include establishing the specialized research team and equipment necessary to perform future mechanistic studies and clinical trials of VR and VR/hypnosis, as well as collect pilot clinical data to direct future investigations. Long-term benefits include the establishment of indications and clinical protocols for the use of VR and/or hypnosis in the treatment of rehabilitation-induced and disability-related pain in this challenging patient population, with more widespread application to a variety of age groups, greater ease of use, and potential economic benefit.
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