Virtual reality as complementary pain therapy in hospitalized patients with sickle cell disease

Abstract

Objective Due to incomplete management of vaso‐occlusive pain episodes (VOE) in patients with sickle cell disease (SCD), we sought to determine if immersive VR would be feasible for inpatients. Secondarily, we hypothesized that a single VR session would improve the VOE pain experience. Procedures Consecutive patients with SCD eight years and older admitted for VOE were offered one 15‐minute VR session, utilizing a relaxing underwater world specifically created for pediatric patients and to minimize potential simulator side effects. Safety and acceptability were evaluated with a brief survey before and after the session. Pain was evaluated utilizing the validated adolescent pediatric pain tool (APPT). Survey data and pain scores were analyzed using Wilcoxon signed‐rank test as the data were nonnormally distributed. Results Thirty patients, 21 female, with a median age of 16 years were enrolled, the majority having hemoglobin SS disease. The VR session had no reported side effects; all patients requested VR again in the future. Median pain intensity (pre‐VR 7.3 [interquartile range, IQR, 6.1, 8.8], post‐VR 5.8 [4.7, 7.9]), number of affected body areas (pre‐VR 3.0 [2.0, 7.8], post‐VR 2.0 [0, 4.8]), and qualitative measures including sensory, affective, evaluative, and temporal pain domains were all statistically reduced (i.e., P ≤0.01). Conclusions VR therapy was feasible in a cohort of patients with SCD admitted for VOE. In addition to standard therapies, VR may help reduce the pain experience with SCD VOE. Further study is required to determine the impact of VR therapy on opioid usage and length of stay in hospital.

Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study

“…Moreover, subjective clinician, parent, and patient report of engagement, distraction, immersion, and enjoyment of the process were consistent with prior work [14,23,24]. The multisession daily reports indicated decreased pain, fear, avoidance, and functional impairments across VR sessions and this result is consistent with prior work [15,[25][26][27]. Given that these changes were observed in the context of IIPT, it is possible the changes reflect general versus VR-specific effects, and thus it is necessary to conduct a more controlled pilot trial to measure the impact of VR on pain rehabilitation.…”

Does virtual reality reduce pain in pediatric patients? A systematic review

“…Results showed the feasibility of the study and a reduction of median pain intensity: Pre-VR = 7.3; Post-VR = 3.0. In addition, the number of affected body areas decreased: pre-VR = 3.0 post-VR = 2.0 [5]. Al-Halabi et al used VR to reduce pain in child behavior management during an inferior alveolar nerve block.…”

“…We analyzed the pain reduction by comparing the indicated values with and without VR, with conflicting results. These studies reported a pain reduction of: 4/10 [5], 2.57/5 [10], 1.78 and 1.39 [8], 2.89 ± 0.2/10 [7], 3/10 [6], 1.15 ± 0.28/5 [12], 2.37/10 [13], and other didn’t show statistical differences [9, 11].…”

Use of virtual reality for epidural placement in an adolescent with ischemic priapism

“…Acute pain crises from SCD are often incompletely managed, and patients are often treated with opioids with minimal success 9 . Immersive VR has been shown to decrease pain intensity and pain descriptors for pediatric patients in acute pain crisis from SCD 10 . To date, there are no reports of the use of VR for placement of an epidural catheter in an adolescent patient but our experience is consistent with studies that endorse its use to reduce pain and anxiety in children during invasive procedures 6 .…”