The Effectiveness of Virtual Reality in Managing Acute Pain and Anxiety for Medical Inpatients: Systematic Review

Abstract

Background Virtual reality is increasingly being utilized by clinicians to facilitate analgesia and anxiolysis within an inpatient setting. There is however, a lack of a clinically relevant review to guide its use for this purpose. Objective To systematically review the current evidence for the efficacy of virtual reality as an analgesic in the management of acute pain and anxiolysis in an inpatient setting. Methods A comprehensive search was conducted up to and including January 2019 on PubMed, Ovid Medline, EMBASE, and Cochrane Database of Systematic reviews according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms included virtual reality, vr, and pain. Primary articles with a focus on acute pain in the clinical setting were considered for the review. Primary outcome measures included degree of analgesia afforded by virtual reality therapy, degree of anxiolysis afforded by virtual reality therapy, effect of virtual reality on physiological parameters, side effects precipitated by virtual reality, virtual reality content type, and type of equipment utilized. Results Eighteen studies were deemed eligible for inclusion in this systematic review; 67% (12/18) of studies demonstrated significant reductions in pain with the utilization of virtual reality; 44% (8/18) of studies assessed the effects of virtual reality on procedural anxiety, with 50% (4/8) of these demonstrating significant reductions; 28% (5/18) of studies screened for side effects with incidence rates of 0.5% to 8%; 39% (7/18) of studies evaluated the effects of virtual reality on autonomic arousal as a biomarker of pain, with 29% (2/7) demonstrating significant changes; 100% (18/18) of studies utilized a head mounted display to deliver virtual reality therapy, with 50% being in active form (participants interacting with the environment) and 50% being in passive form (participants observing the content only). Conclusions Available evidence suggests that virtual reality therapy can be applied to facilitate analgesia for acute pain in a variety of inpatient settings. Its effects, however, are likely to vary by patient population and indication. This highlights the need for individualized pilot testing of virtual reality therapy’s effects for each specific clinical use case rather than generalizing its use for the broad indication of facilitating analgesia. In addition, virtual reality therapy has the added potential of concurrently providing procedural anxiolysis, thereby improving patient experience and cooperation, while being associated with a low incidence of side effects (nausea, vomiting, eye strain, and dizziness). Furthermore, findings indicated a head mounted display should be utilized to deliver virtual reality therapy in a clinical setting with a slight preference for active over passive virtual reality for analgesia. There, however, appears to be insufficient evidence to substantiate the effect of virtual reality on autonomic arousal, and this should be considered at best to be for investigational uses, at present.

Virtual Reality for Sedation During Atrial Fibrillation Ablation in Clinical Practice: Observational Study

“…Indeed, only a mean of 1.2 mg and 1.1 mg were needed on top of the initial bolus in the VR and control groups, respectively. Overall, our results are in line with the literature [ 24 ]. In a recent systematic review, Smith et al [ 24 ] suggested that VR was effective for analgesia in a variety of different clinical settings but could also have disadvantages.…”

Effect of Immersive Virtual Reality on Pain and Anxiety at a Veterans Affairs Health Care Facility

“…The Gate Control, Multiple Resource, and Neuromatrix Theories of Pain explain the mechanism of action of VR in pain reduction. These theories purport that pain is influenced by sensory, affective, and cognitive inputs (Basil, 1994;Indovina et al, 2018;Smith et al, 2020). Since the human brain has a finite processing capacity, VR saturates the brain with engaging positive stimuli thus blocking/distracting from the pain signals resulting in pain reduction (Kahneman, 1973;Eccleston, 1999Eccleston, , 2001Hoffman et al, 2007Hoffman et al, , 2011Tack, 2019;Hoffman, 2021).…”

“…An estimated 20% of the world's population lives in chronic pain (Goldberg and McGee, 2011) and 17.6% of those in chronic pain in the U.S. rate their pain as severe (Nahin, 2015;Becker et al, 2017). Traditional treatments for pain have relied on medications, in particular opioids, or invasive interventions, such as nerve blocks or epidural injections, each with their own risk profile (Benyamin et al, 2008;Bellini and Barbieri, 2013;Jung et al, 2014;Teater, 2014;Webster, 2017;Liberman et al, 2019;Chuan et al, 2020;Smith et al, 2020). In light of the current opioid overdose death crisis, there is an urgent need for implementation of noninvasive complementary and alternative modalities for the treatment of pain, both acute and chronic.…”

Current Insights into 3D Bioprinting: An Advanced Approach for Eye Tissue Regeneration

“…Although the previously mentioned technical requirements can be fulfilled by increased research knowledge, there are still some relevant concerns related to both ethical and regulatory aspects that jeopardize the road to clinic of this "game changer" technology [1,2].…”

“…The development of new revolutionary technologies during recent years, such as the use of Big Data, virtual reality systems and three-dimensional (3D) bioprinting, has created great expectations in the scientific community, not only regarding the improvement of the quality of life in patients affected by devastating pathologies, but also in terms of saving health-care associated resources [1][2][3]. In this regard, 3D bioprinting is an emerging manufacturing technology which holds great promise for a wide variety of biomedical applications, including drug testing, pathophysiological studies and regenerative medicine [4].…”