title: Predicting the effectiveness of virtual reality relaxation on pain and anxiety when added to PCA morphine in patients having burns dressings changes.
abstract: BACKGROUND
  Pain arising in burns sufferers is often severe and protracted. The prospect of a dressing change can heighten existing pain by impacting both physically and psychologically. In this trial we examined whether pre-procedural virtual reality guided relaxation added to patient controlled analgesia with morphine reduced pain severity during awake dressings changes in burns patients.
  
  
  METHODS
  We conducted a prospective randomized clinical trial in all patients with burns necessitating admission to a tertiary burns referral centre. Eligible patients requiring awake dressings changes were randomly allocated to single use virtual reality relaxation plus intravenous morphine patient controlled analgesia (PCA) infusion or to intravenous morphine patient controlled analgesia infusion alone. Patients rated their worst pain intensity during the dressing change using a visual analogue scale. The primary outcome measure was presence of 30% or greater difference in pain intensity ratings between the groups in estimation of worst pain during the dressing change.
  
  
  RESULTS
  Of 88 eligible and consenting patients having awake dressings changes, 43 were assigned to virtual reality relaxation plus intravenous morphine PCA infusion and 43 to morphine PCA infusion alone. The group receiving virtual reality relaxation plus morphine PCA infusion reported significantly higher pain intensities during the dressing change (mean=7.3) compared with patients receiving morphine PCA alone (mean=5.3) (p=0.003) (95% CI 0.6-2.8).
  
  
  CONCLUSIONS
  The addition of virtual reality guided relaxation to morphine PCA infusion in burns patients resulted in a significant increase in pain experienced during awake dressings changes. In the absence of a validated predictor for responsiveness to virtual reality relaxation such a therapy cannot be recommended for general use in burns patients having awake dressings changes.
authors.affiliation: c/o Alfred Hospital, Department of Anaesthesia and Perioperative Medicine, Commercial Road, Melbourne 3004, Australia. a.konstantatos@alfred.org.au
authors.forename: A H
authors.initials: AH
authors.lastname: Konstantatos
authors.forename: M
authors.initials: M
authors.lastname: Angliss
authors.forename: V
authors.initials: V
authors.lastname: Costello
authors.forename: H
authors.initials: H
authors.lastname: Cleland
authors.forename: S
authors.initials: S
authors.lastname: Stafrace
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001007:Anxiety / Q000517:prevention & control* / Q000523:psychology; D001458:Bandages; D002056:Burns / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D003198:Computer Simulation; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology; D010147:Pain Measurement; D011446:Prospective Studies; D012064:Relaxation Therapy / Q000379:methods*; D013813:Therapy, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine