Virtual reality reduces pain in palliative care–A feasibility trial

Abstract

Background Effective symptom control is a stated goal of palliative care (PC) to improve quality of life for terminally ill patients. Virtual reality (VR) provides temporary escapes from pharmacologically resistant pain and allows for experiences and journeys patients may not access in any other way. Enabling wishes through virtual worlds may also offer additional benefits such as controlling psychological and physical symptoms. Aims We investigated the feasibility of a single VR experience as a viable, satisfying, and effective tool for end-of-life pain relief for inpatients presenting palliative needs. Design This is an observational, single-arm and national single-center feasibility trial. Methods A one-time VR experience with a selection of several videos and games was offered to 45 inpatients receiving PC at Muenster University Hospital. Patients with brain tumors, brain metastases, seizures, motion sickness, claustrophobia, vertigo, hearing or visual impairment, or unable to consent were excluded. Primary outcome measured patient reported pain on a visual analogue scale (VAS). We also measured Karnofsky performance status, health-related quality of life (HRQOL) using the EQ-5D-5 L questionnaire, and the Pain Out Questionnaire for postoperative pain. Results We analyzed data from 21 women (52.5%) and 19 men (47.5%) at an average age of 51.9 (SD: 15.81) years. The mean Karnofsky score among the sample was 45.5 (SD: 14.97) and the HRQOL was 41.9 (SD: 23.08). While no serious side effects were reported during the intervention, three patients experienced nausea (7%), two headaches (5%), and three reported dry eyes (7%) afterwards. Significant pain reduction (baseline VAS 2.25 (SD: 0.4399)) was demonstrated during (VAS 0.7 (SD: 0.2983, p < 0.0001)), immediately after (VAS 0.9 (SD: 0.3354, p = 0.0001)) and one hour after the intervention (VAS 1.15 (SD: 0.4163, p = 0.0004)). More than 80% rated the VR experience as very good or good (85%, n = 34) and intended to make use of the device again (82.5%, n = 33). However, two participants (5%) also expressed sadness by becoming aware of old memories and previous opportunities that are gone. Discussion The present pilot study suggests that VR seems to be a feasible and effective tool for pain relief in PC. Its use encompasses the approach of a total pain and symptom therapy and enhances patients’ dignity and autonomy. Future research ought to include if and to what extent VR could reduce the necessity of pharmacological pain relief.

A Rapid Review of the Role of Virtual Reality in Care Delivery of Palliative Care and Hospice

“…Of the 14 studies, 5 explored the use of VR as an intervention for pain and symptom management 20-22,24,25 . Four studies focused specifically on the role of VR in relieving cancer-related pain and symptoms 18,22,24,25 .…”

“…Virtual reality included computer-simulated environments 9,15,21 with an overarching immersive component 16,17,20,22-25 . Computer-generated imagery, 22,26 a 360° aspect ratio and 3-dimensional, 16-18,20 and virtual worlds 20,23 detailed the experience for the participant. Head-mounted displays were used in nearly all of the studies 16-20,22,24-28 .…”

“…Computer-generated imagery, 22,26 a 360° aspect ratio and 3-dimensional, 16-18,20 and virtual worlds 20,23 detailed the experience for the participant. Head-mounted displays were used in nearly all of the studies 16-20,22,24-28 . Hand controllers, 17,22 joy sticks, 18 screens, 20,22 and a VR facilitator 23 were also integrated as part of the experience.…”

“…Hand controllers, 17,22 joy sticks, 18 screens, 20,22 and a VR facilitator 23 were also integrated as part of the experience. Reports of sore shoulders, improper sizing, and heaviness of the HMDs were reported by patients 16,20,21,26 . Conversely, HMDs were more flexible devices compared with stereoscopic displays and also allowed for mobility 21 …”

The role of virtual reality as adjunctive therapy to spinal cord stimulation in chronic pain: A feasible concept?

“…The ability of VR therapy to acutely reduce pain has been wellestablished in various contexts, including during procedures, postsurgical recovery, cancer pain, palliative care, and among patients suffering from chronic pain (25)(26)(27)(28). Most reviewed studies use pain intensity, commonly measured by a visual analog scale (VAS) or a numeric rating scale (NRS), as the primary outcome.…”