Pain
Conditions
Keywords
Pain management, Hypnosis, Virtual Reality, Distractibility methods
Brief summary
The originality of this study is the comparison of different distractibility techniques (hypnosis and virtual reality) in the very heterogenous contexts of pain management. This study will consider all types of care situations. The study's cross-over design will take into account this heterogenous context. The results will be representative of real-life situations where care for pain involves a wide range of contexts.
Detailed description
Pain is defined as an unpleasant sensorial and emotional experience related to a potential or existing tissue injury (psychological (affective) and physical dimension of pain). Since it can occur at any stage of care, pain concerns all healthcare teams working in acute care units or follow-up care centers. At the present time, pain management is mainly based on the use of analgesic agents that calm or suppress pain. Different types of analgesic agents are available in the therapeutic armamentarium (non-opioid analgesics and opioid analgesics as morphine). In this context where pain management is a priority and where the use of morphine is constantly on the rise exposing patients to significant risk (adverse effects, addictions, respiratory events….), the use of distractibility techniques as hypnosis and virtual reality could be an attractive alternative. * Hypnosis designates both a therapeutic technique and a modified state of consciousness also called trance (a state where the person is between a state of wakefulness and sleep). * Virtual reality designates a three-dimensional computer-controlled environment allowing immersion, interaction and multisensorial input. Thus, the originality of this study is the comparison of different distractibility techniques in the very heterogenous contexts of pain management. This study will consider all types of care situations. The study's cross-over design will take into account this heterogenous context. The results will be representative of real-life situations where care for pain involves a wide range of contexts.
Interventions
OTHERManagement pain with distraction methods ABC
Every patient will receive : * The usual pain management of their ward (Treatment A), * The usual pain management of their ward with a hypnosis session (Treatment B) * The usual pain management of their ward with a virtual reality session (Treatment C)
OTHERManagement pain with distraction methods BCA
Every patient will receive : * The usual pain management of their ward with a hypnosis session (Treatment B) * The usual pain management of their ward with a virtual reality session (Treatment C) * The usual pain management of their ward (Treatment A)
OTHERManagement pain with distraction methods CAB
Every patient will receive : * The usual pain management of their ward with a virtual reality session (Treatment C) * The usual pain management of their ward (Treatment A) * The usual pain management of their ward with a hypnosis session (Treatment B)
Sponsors
Lille Catholic University
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Controlled, randomised, open-label, cross-over, 3-sequence study (uniform design across time and sequence: ABC/BCA/CAB). * Treatment A: Usual pain management of each ward * Treatment B: Usual pain management on each ward and analgesic hypnotherapy during care * Treatment C: Usual pain management of each ward and virtual reality session using a suitable headset.
Eligibility
Sex/Gender
ALL
Age
15 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients undergoing care interventions of a given type (e.g. wound dressings/mobilization/…) recognized as painful (pain VAS \>3 despite the usual analgesic protocol) * Repetition of the same type of intervention at least three times within a month of interval after inclusion * Patient age ≥15 years * Informed consent from patient or legal guardian * Beneficiary of the French healthcare fund
Exclusion criteria
* MEOPA's administration during painful treatment as part of the study * Cognitive or psychiatric disorders preventing the patient from communicating with caregivers or understanding their instructions * Any other concomitant nervous system, cardiac, or pulmonary disease that might affect the autonomous nervous system: (myocardial infarction, myocardial disorder (e.g. dilated or hypertrophic cardiomyopathy), class 3 or 4 heart failure, cardia dysrhythmia, including atrial fibrillation, conduction disorder, mechanical ventilation) * Non-sinusal rhythm, extrasystoles, altered ECG signals related to heart disease * Mandatory drug therapy that might affect the autonomous nervous system and NRV such as beta-blockers, muscarinic receptor blockers (mainly atropine, scopolamine), vasopressin agents * Contraindication for use of the virtual reality headset and/or hypnosis. Neurological disorder incompatible with use of the virtual reality headset and/or hypnosis (balance disorders/seizures…) * Contraindication for using surface electrodes preventing collection of the main endpoint data * Any disorder or disability preventing execution of the virtual reality or hypnosis techniques (deafness/blindness) * Judicial protection status
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Analgesia Nociception Index (ANI) during painful care interventions | one month | This index is derived from heart rate variability and reflects the relative parasympathetic tone. An ANI value close to 100 corresponds to a prominent parasympathetic tone (low stress level, analgesia) and a value close to 0 corresponds to a prominent sympathetic tone (high stress level, nociception). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ANI's average score (Analgesia Nociception Index) 5 minutes after the care and the distractibility methods | one month | A comparison between the ANI's score before and after the care and the distractibility methods. The average of the scores will be retained. |
| Morphine equivalent | one month | The opioid analgesics administered during the care will be converted into morphine equivalent by means of the opioid equi-analgesia table. The collection of analgesics will include all analgesics in action on the day of care. |
| Proportion of patients tolerance to distractibility techniques | one month | All events leading to a discontinuation of the distractibility technique will be recorded: side effects /cybersickness (nausea, vertigo evaluated using the Speech, Spatial and Qualities (SSQ) of Hearing Scale prolonged procedure, dissociative disorders …), patient refusal, care-related elements preventing the use of the distractibility technique or leading to premature discontinuation of its use. |
| Correlation between patient age and tolerance | one month | The impact of age on abandon (irrespective of the reason) will be noted to search for a link between age and tolerance. |
| Visual Analog Scale (VAS) | one month | The pain's level will be evaluated by the Visual Analog Scale (VAS). This scale measure the pain's intensity from 0 to 10. |
| Correlation between caregiver training level and hypnosis efficacy | one month | Hypnosis training level will be determined by the duration of training (hours) and the professional level (1/2/3). Caregiver category (nurse/psychologist/rehabilitation specialist…) and the number of hypno-therapy sessions delivered during the six months preceding the study will also be considered. |
| Percentage of satisfaction concerning the distractibility techniques. | one month | A questionnaire will evaluate patient perceptions concerning the distractibility techniques. |
| IPQ (Igroup Presence Questionnaire) scale | one month | The IPQ is a 14-item self-administered questionnaire. This scale is used to measure the patient's feelings about spatial presence, the implication and sense of the reality perceived in the virtual reality. |
| Correlation between patient age and treatment efficacy | one months | The impact of age on treatment effect on ANI score during the care procedure will be noted to search for a link between age and treatment efficacy. |
Countries
France
Outcome results
None listed