[Multimodal distraction to relieve pain in children undergoing acute medical procedures].
OBJECTIVE
Non-pharmacological approaches to pain management have been used by therapists for decades to reduce the anxiety and pain experienced by children during burn care procedures. With a greater understanding of pain and the principles behind what causes a child to be distracted, combined with access to state of the art technology, we have developed an easy to use, hand held multimodal distraction device (MMD). MMD is an interactive device that prepares the child for a procedure and uses developmentally appropriate distraction stories and games during the procedures to alleviate anxiety and pain. This paper summarizes the results of three randomized control trials. The trials aimed to understand the effectiveness of MMD as a distraction and preparation tool in reducing anxiety and pain in children undergoing burns and non-burns medical procedures compared to pure pharmacological approaches Standard Distraction (SD) and off the shelf video games (VG).


METHODS
Three separate prospective randomized control trials involving 182 children having 354 dressing changes were conducted in the burns and orthopedic departments at Royal Children's Hospital, Brisbane, Australia, to address the above aims. Pain and anxiety scores were completed for the child, caregiver and nursing staff according to the Modified Faces, Legs, Activity, Cry and Consolability Scale, Faces Pain Scale-Revised, Visual Analogue Scale and Wong-Baker Faces Pain Rating Scale. Procedural length was recorded.


RESULTS
MMD as a preparation and distraction tool were shown to have a significant impact on child, parent and nursing staff reported anxiety and pain during procedures compared to standard care and video games (P < 0.01). The MMD had a positive effect on clinical time and was shown to sustain its impact on pain and time with further dressing changes.


CONCLUSIONS
MMD is more effective in reducing the pain and anxiety experienced by children in acute medical procedures as compared with SD and VG. MMD is continuing to be trialed and is continuing to show positive clinical outcomes.
Miller
Kate
K
Stuart Pegg Paediatric Burns Centre, The University of Queensland, Brisbane, 4029, Australia. kate.miller@uq.edu.au
Rodger
Sylvia
S
Bucolo
Sam
S
Wang
Xue-Qing
XQ
Kimble
Roy M
RM
D000293:Adolescent; D000698:Analgesia / Q000295:instrumentation* / Q000379:methods; D002056:Burns / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000523:psychology; D059408:Pain Management; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D014584:User-Computer Interface; D018910:Video Games