Abstract
BackgroundPatients with secondary pain due to mucositis after chemotherapy require treatment with morphine. Use of electronic video games (EVGs) has been shown to be an effective method of analgesia in other clinical settings.ObjectiveThe main objective of this study was to assess the association between the use of EVGs and the intensity of pain caused by chemotherapy-induced mucositis in pediatric patients with cancer. The secondary objective was to assess the association between changes in pain intensity and sympathetic-parasympathetic balance in this sample of pediatric patients.MethodsClinical records were compared between the day prior to the use of EVGs and the day after the use of EVGs. The variables were variations in pupil size measured using the AlgiScan video pupilometer (IDMed, Marseille, France), heart rate variability measured using the Analgesia Nociception Index (ANI) monitor (Mdoloris Medical Systems, Loos, France), intensity of pain measured using the Numerical Rating Scale (score 0-10), and self-administered morphine pump parameters.ResultsTwenty patients (11 girls and nine boys; mean age 11.5 years, SD 4.5 years; mean weight 41.5 kg, SD 20.7 kg) who met all the inclusion criteria were recruited. EVGs were played for a mean of 2.3 (SD 1.3) hours per day, resulting in statistically significant changes. After playing EVGs, there was significantly lower daily morphine use (before vs after playing EVGs: 35.9 vs 28.6 µg/kg/day, P=.003), lower demand for additional pain relief medication (17 vs 9.6 boluses in 24 hours, P=.001), lower scores of incidental pain intensity (7.7 vs 5.4, P=.001), lower scores of resting pain (4.8 vs 3.2, P=.01), and higher basal parasympathetic tone as measured using the ANI monitor (61.8 vs 71.9, P=.009). No variation in pupil size was observed with the use of EVGs.ConclusionsThe use of EVGs in pediatric patients with chemotherapy-induced mucositis has a considerable analgesic effect, which is associated physiologically with an increase in parasympathetic vagal tone despite lower consumption of morphine.
Highlights
Pediatric patients with cancer may experience chronic pain associated with the development of the illness itself, which is caused by compression or infiltration of nearby organs or nerves or by pathologic bone fractures
electronic video games (EVGs) were played for a mean of 2.3 (SD 1.3) hours per day, resulting in statistically significant changes
No variation in pupil size was observed with the use of EVGs
Summary
Pediatric patients with cancer may experience chronic pain associated with the development of the illness itself, which is caused by compression or infiltration of nearby organs or nerves or by pathologic bone fractures. Chemotherapy-induced mucositis (International Classification of Diseases 10th Revision: K12.30; International Classification of Diseases 11th Revision: DA01.11) is a relatively common complication associated with the use of chemotherapy in the treatment of young patients with cancers, such as leukemia [2]. It is associated with intense pain, and it has a considerable impact on patient quality of life, patient mood, and the current and future evolution of the illness [3]. Use of electronic video games (EVGs) has been shown to be an effective method of analgesia in other clinical settings
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