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April 21, 2020
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The Association Between Pain Relief Using Video Games and an Increase in Vagal Tone in Children With Cancer: Analytic Observational Study With a Quasi-Experimental Pre/Posttest Methodology

Publicated to:JOURNAL OF MEDICAL INTERNET RESEARCH. 22 (3): e16013- - 2020-03-01 22(3), DOI: 10.2196/16013

Authors: Alonso-Prieto M; Miró J; Torres-Luna R; Plaza López de Sabando D; Reinoso-Barbero F

Affiliations

Hospital Universitario La Paz - Author
Rovira & Virgili Univ, Dept Psychol, Unit Study & Treatment Pain ALGOS, Tarragona, Spain - Author
Univ Autonoma Madrid, Sch Med, Dept Anat Histol & Neurosci, Madrid, Spain - Author
Univ La Paz Hosp, Anesthesiol Crit Care Serv, Pediat Pain Unit, Paseo Castellana 261, Madrid 28046, Spain - Author
Univ La Paz Hosp, Pediat Hematooncol Serv, Madrid, Spain - Author
Universidad Autónoma de Madrid - Author
Universitat Rovira i Virgili - Author
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Abstract

©Mercedes Alonso-Prieto, Jordi Miró, Raquel Torres-Luna, Diego Plaza López de Sabando, Francisco Reinoso-Barbero. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.03.2020. BACKGROUND: Patients 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. OBJECTIVE: The 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. METHODS: Clinical 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. RESULTS: Twenty 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. CONCLUSIONS: The 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.

Keywords

acute painanalgesia nociception indexhematology oncologypatient-controlled analgesiapediatric patientAcute painAnalgesia nociception indexHematology oncologyPatient-controlled analgesiaPediatric patientVideo pupilometer

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal JOURNAL OF MEDICAL INTERNET RESEARCH due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2020, it was in position 10/108, thus managing to position itself as a Q1 (Primer Cuartil), in the category Health Care Sciences & Services. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 4.71, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-05, the following number of citations:

  • WoS: 3
  • Scopus: 4
  • Europe PMC: 2
  • Google Scholar: 3

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-05:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 72.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 72 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 131.6.
  • The number of mentions on the social network X (formerly Twitter): 81 (Altmetric).
  • The number of mentions in news outlets: 8 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (REINOSO BARBERO, FRANCISCO).