Virtual Reality Distraction to Help Control Acute Pain during Medical Procedures

Self Cite

Immersive virtual reality is proving effective as a non-pharmacologic analgesic for a growing number of painful medical procedures. External fixator surgical pins provide adjunctive stability to a broken pelvic bone until the bones heal back together, then pins are removed. The purpose of the present case study was to measure for the first time, whether immersive virtual reality could be used to help reduce pain and anxiety during the orthopedic process of removing external fixator pins from a conscious patient in the orthopedic outpatient clinic, and whether it is feasible to use VR in this context. Using a within-subject within wound care design with treatment order randomized, the patient had his first ex-fix pin unscrewed and removed from his healing pelvic bone while he wore a VR helmet and explored an immersive snowy 3D computer generated world, adjunctive VR. He then had his second pin removed during no VR, standard of care pain medications. The patient reported having 43% less pain intensity, 67% less time spent thinking about pain, and 43% lower anxiety during VR vs. during No VR. In addition, the patient reported that his satisfaction with pain management was improved with the use of VR. Conducting simple orthopedic procedures using oral pain pills in an outpatient setting instead of anesthesia in the operating room greatly reduces the amount of opioids used, lowers medical costs and reduces rare but real risks of expensive complications from anesthesia including oversedation, death, and post-surgical dementia. These preliminary results suggest that immersive VR merits more attention as a potentially viable adjunctive non-pharmacologic form of treatment for acute pain and anxiety during medical procedures in the orthopedic outpatient clinic. Recent multi-billion dollar investments into R and D and mass production have made inexpensive immersive virtual reality products commercially available and cost effective for medical applications. We speculate that in the future, patients may be more willing to have minor surgery procedures in the outpatient clinic, with much lower opioid doses, while fully awake, if offered adjunctive virtual reality as a non-pharmacologic analgesic during the procedure. Additional research and development is recommended.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Case Report: Virtual Reality Analgesia in an Opioid Sparing Orthopedic Outpatient Clinic Setting: A Case Study

Firoozabadi

El-Haddad

Drever

et al. 2020

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“…One of the main differences with the extant literature on the effect of interaction in virtual environments (VE) is that we did not provide any visual cues in our VEs that could provide expectancy effects that could interfere or interact with the perspective, as previous literature has shown that environmental interaction compared to no interaction is significantly more analgesic (Lier et al, 2020). In line with the theory of attentional demand (Hoffman et al, 2019), we hypothesized that the incongruent visuomotor information experienced during the third person perspective would demand an increase in attentional capacity and therefore further distract the individuals from the painful stimuli, resulting in a relatively lower physiological stress response and lower subjective ratings compared to the first person perspective.…”

Section: Introductionmentioning

confidence: 95%

Affective and Physiological Responses During Acute Pain in Virtual Reality: The Effect of First-Person Versus Third-Person Perspective

Turbyne

Koning

Smit

et al. 2021

Background: Virtual reality (VR) has been previously shown as a means to mitigate acute pain. The critical parameters involved in the clinical efficacy of mitigating acute pain from different perspectives remains unknown. This study attempted to further deconstruct the critical parameters involved in mitigating acute pain by investigating whether affective and physiological responses to painful stimuli differed between a first and a third person perspective in virtual reality.Methods: Two conditions were compared in a repeated-measures within subject study design for 17 healthy participants: First person perspective (i.e., where participants experienced their bodies from an anatomical and egocentric perspective) and third person perspective (i.e., where participants experienced their bodies from an anatomical perspective from across the room). The participants received noxious electrical stimulation at pseudorandom intervals and anatomical locations during both conditions. Physiological stress responses were measured by means of electrocardiography (ECG) and impedance cardiography (ICG). Subjective scores measuring tension, pain, anger, and fear were reported after every block sequence.Results: There were no significant differences in physiological stress responses between conditions. However, the participants reported significantly higher tension during the third person condition.Conclusion: Relative to a third person perspective, there are no distinct physiological benefits to inducing a first person perspective to mitigate physiological stress responses to acute pain in healthy individuals. However, there may be additional clinical benefits for doing so in specific clinical populations that have shown to benefit from relaxation techniques. Further research is needed in order to refine the clinical utility of different perspectives during virtual reality immersions that serve to act as a non-pharmacological analgesic during acute pain.

“…As in most or all of the previous studies by our team (e.g., see Hoffman et al, 2019a, 2020 for reviews), worst pain intensity was selected as the primary outcome measure in the current study. Worst pain is the measure most highly correlated with functional interference (Harris et al, 2007), and worst pain (sensory pain) is considered the pain measure that matters the most to the patient, the best measure of therapeutic effect.…”

Section: Test Of Primary Hypothesismentioning

confidence: 99%

“…Immersive virtual reality (VR) is proving to be an unusually effective non-drug pain control technique. VR has been shown to reduce pain and anxiety during burn care (Hoffman et al, 2000a(Hoffman et al, , 2001(Hoffman et al, , 2014Sharar et al, 2007;Carrougher et al, 2009;Soltani et al, 2018), dental procedures (Atzori et al, 2018a), venipuncture (Gold et al, 2006(Gold et al, , 2007Atzori et al, 2018b;Gold and Mahrer, 2018), blunt force trauma (Hoffman et al, 2009), and a number of other painful medical procedures (see Hoffman et al, 2000bHoffman et al, , 2011Hoffman et al, , 2019aHoffman et al, , 2020Keefe et al, 2012;Garrett et al, 2014 for reviews). Several studies have explored the effectiveness of VR pain reduction during burn wound cleaning of burn patients treated for smaller injuries [i.e., <10% Total Body Surface Area (TBSA); (Faber et al, 2013;Garrett et al, 2014;Jeffs et al, 2014;Khadra et al, 2020)].…”

Section: Introductionmentioning

confidence: 99%

Virtual Reality Analgesia for Children With Large Severe Burn Wounds During Burn Wound Debridement

Hoffman

Patterson

Rodriguez

et al. 2020

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The objective of this study was to compare the effect of adjunctive virtual reality vs. standard analgesic pain medications during burn wound cleaning/debridement. Participants were predominantly Hispanic children aged 6–17 years of age, with large severe burn injuries (TBSA = 44%) reporting moderate or higher baseline pain during burn wound care. Using a randomized between-groups design, participants were randomly assigned to one of two groups, (a) the Control Group = pain medications only or (b) the VR Group = pain medications + virtual reality. A total of 50 children (88% Hispanic) with large severe burns (mean TBSA > 10%) received severe burn wound cleaning sessions. For the primary outcome measure of worst pain (intensity) on Study Day 1, using a between groups ANOVA, burn injured children in the group that received virtual reality during wound care showed significantly less pain intensity than the No VR control group, [mean worst pain ratings for the No VR group = 7.46 (SD = 2.93) vs. 5.54 (SD = 3.56), F(1,48) = 4.29, < 0.05, MSE = 46.00]. Similarly, one of the secondary pain measures, “lowest pain during wound care” was significantly lower in the VR group, No VR = 4.29 (SD = 3.75) vs. 1.68 (2.04) for the VR group, F(1,47) = 9.29, <0.005, MSE = 83.52 for Study Day 1. The other secondary pain measures showed the predicted pattern on Study Day 1, but were non-significant. Regarding whether VR reduced pain beyond Study Day 1, absolute change in pain intensity (analgesia = baseline pain minus the mean of the worst pain scores on Study days 1–10) was significantly greater for the VR group, F(1,48) = 4.88, p < 0.05, MSE = 34.26, partial eta squared = 0.09, but contrary to predictions, absolute change scores were non-significant for all secondary measures.