Virtual Reality to Relieve Pain in Burn Patients Undergoing Imaging and Treatment

Bermo, Mohammed; Patterson, David R.; Sharar, Sam R.; Hoffman, Hunter G.; Lewis, David H.

doi:10.1097/rmr.0000000000000248

Cited by 24 publications

(13 citation statements)

References 52 publications

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“…The potential psychological mechanism is shown in gate control theory (Melzack and Wall 1965) such that VR induces attentional shifting with less cognitive focus on the noxious stimuli, resulting in a decrease in the experience of pain and anxiety (Gold et al 2007;Triberti et al 2014). VR has been demonstrated to modulate pain-related brain activity at the cortical and subcortical levels, which correlated with subjective improvement in pain perceptions (Hoffman et al 2006;Hoffman et al 2007;Bermo et al 2020). We hypothesized that VR distraction would attenuate patients' anxiety and pain and consequently maintain the BP and HR.…”

Section: Introductionmentioning

confidence: 99%

Virtual Reality for Hypertension in Tooth Extraction: A Randomized Trial

et al. 2021

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Tooth extraction is one of the most common causes of dental anxiety and pain, leading to the elevation of blood pressure (BP) and heart rate (HR). Such effects may be exaggerated and cause life-threatening accidents in patients with hypertension. Therefore, the pain and anxiety management of these patients is imperative. Virtual reality (VR) has been demonstrated to be a distraction method to relieve anxiety and pain in clinical operations. Thus, we hypothesized that VR can control the elevation of BP and HR in patients with hypertension. In this study, 96 eligible patients with controlled hypertension who needed tooth extraction were randomized to the VR or standard care group by stratified randomization of anxiety grade and gender. Their BP and HR were dynamically monitored. The corresponding systolic and diastolic BP and HR values were selected when systolic BP was at the highest point of the process. BP was converted into mean arterial pressure (MAP) for comparison per the following formula: MAP = (systolic BP + 2 × diastolic BP)/3. Statistical analyses were by intention to treat and conducted in SPSS. Nonparametric rank sum tests were used to compare the difference of ΔMAP and ΔHR between the VR and standard care groups. Multivariate linear regression was applied to evaluate the effect of VR on ΔMAP and ΔHR. The results showed that the VR technique significantly decreased the elevation of MAP ( P < 0.001) and HR ( P < 0.001), and this effect was found even after adjusting for baseline characteristics and additional surgical procedures (ΔMAP, P < 0.001, R2 = 0.276; ΔHR, P < 0.001, R2 = 0.152). VR did not increase the incidence of adverse events ( P = 0.677). In conclusion, the VR technique was effective in controlling BP and HR within an acceptable range and can help manage BP and HR during tooth extraction for patients with hypertension (Chinese Clinical Trial Registry: ChiCTR2100042132).

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Section: Introductionmentioning

confidence: 99%

Virtual Reality for Hypertension in Tooth Extraction: A Randomized Trial

et al. 2021

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“…In other words, the brain can send signals down to the spinal cord, which reduce (or in some cases increase) the amount of nociceptive signals allowed to travel from the spinal cord to the brain. This control system has a cortical component at the anterior cingulate and prefrontal cortex and subcortical components at certain brainstem nuclei ( 3 , 25 , 34 – 39 ). A small but important study in two subjects who are “pain-free” due to SCN9A mutation, showed activation of the pain matrix during laboratory mechanical pain applied to the dorsum of their hand, similar to response in 4 normal control subjects ( 40 ).…”

Section: Imaging Of Painmentioning

confidence: 99%

“…A pain processing network model by Garcia et al ( 29 ) suggested that pain is processed at three levels, at an unconscious level processed in peri-Rolandic cortex and limbic system receiving afferent spinothalamic pain signals, at an intermediate awareness level processed at fronto-cingulate-parietal networks in addition to the sensorimotor cortices, and at a higher conscious extended level which includes adding input from memories and self-awareness. The comprehensive pain experience processing network appears to include more regions with contribution from other cortical and subcortical cerebral regions such as the brain stem and the cerebellum ( 3 , 29 ).…”

Section: Imaging Of Painmentioning

confidence: 99%

“…This brain activation pattern can be converted into a computer image after the painful event is over, when the patient can be transported and can stay still in the scanner. The concept of freezing an image of pain-related brain activity that can be imaged later is clinically useful in designing functional brain imaging studies where fMRI is not possible due to MRI unfriendly or incompatible clinical circumstances ( 3 ), e.g., all virtual reality equipment used in the fMRI scanner must be non-ferrous and non-conductive.…”

Section: Introductionmentioning

confidence: 99%

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Utility of SPECT Functional Neuroimaging of Pain

et al. 2021

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Functional neuroimaging modalities vary in spatial and temporal resolution. One major limitation of most functional neuroimaging modalities is that only neural activation taking place inside the scanner can be imaged. This limitation makes functional neuroimaging in many clinical scenarios extremely difficult or impossible. The most commonly used radiopharmaceutical in Single Photon Emission Tomography (SPECT) functional brain imaging is Technetium 99 m-labeled Ethyl Cysteinate Dimer (ECD). ECD is a lipophilic compound with unique pharmacodynamics. It crosses the blood brain barrier and has high first pass extraction by the neurons proportional to regional brain perfusion at the time of injection. It reaches peak activity in the brain 1 min after injection and is then slowly cleared from the brain following a biexponential mode. This allows for a practical imaging window of 1 or 2 h after injection. In other words, it freezes a snapshot of brain perfusion at the time of injection that is kept and can be imaged later. This unique feature allows for designing functional brain imaging studies that do not require the patient to be inside the scanner at the time of brain activation. Functional brain imaging during severe burn wound care is an example that has been extensively studied using this technique. Not only does SPECT allow for imaging of brain activity under extreme pain conditions in clinical settings, but it also allows for imaging of brain activity modulation in response to analgesic maneuvers whether pharmacologic or non-traditional such as using virtual reality analgesia. Together with its utility in extreme situations, SPECTS is also helpful in investigating brain activation under typical pain conditions such as experimental controlled pain and chronic pain syndromes.

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“…The patterns of pain-related brain activity during wound care were temporarily "frozen in time". In the study by Bermo et al (2020), the patient received their usual painful burn wound care/scrubbing in the wound care room, with their usual wound care nurse. Patients received an injection of the tracer, but no scan during wound care.…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Immersive Virtual Reality: A Safe, Scalable, Non-opioid Analgesic for Military and Veteran Patients

Peterson¹,

Hitching

Howard

et al. 2021

Front. Virtual Real.

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In Iraq and Afghanistan over 75% of the combat casualties suffered by U.S. troops have involved explosive devices. Improvements in body armor and advances in military medicine have significantly reduced the number of combat-related fatalities, but have greatly increased the number of U.S. active component personnel suffering painful trauma injuries. Unfortunately, so far, advances in pharmacologic analgesia pain medications have not kept pace with advances in survivability. For many active component personnel and Veterans, pain is a top health complaint from patients. The opioid epidemic has increased the urgency of developing powerful non-pharmacologic approaches for the management of pain. Immersive VR is proving to be a powerful non-opioid pain management technique for acute pain. However, the cost and usability limitations of pre-2016 VR clinical products resulted in limited treatment adoption rates for clinical use. In recent years, VR technology has become increasingly immersive, portable, and miniaturized, requiring minimal technical expertise to operate, and low-cost, factors that are likely contributing to the recent increase in the clinical use of VR analgesia. VR is greatly benefitting from a growing string of major technological breakthroughs and VR treatment improvements that will likely continue to increase the effectiveness and suitability of VR analgesia for military and VA patients. Regarding acute pain, we propose that the next revision to the current Tactical Combat Casualty Care guidelines consider including VR as an effective and hemodynamically safe approach to the current management of acute trauma pain in military personnel during medical procedures. With recent miniaturization and ruggedization, VR can potentially be used closer to the battlefield in the future. Beyond distraction, innovative VR therapy techniques designed to help reduce chronic pain are discussed. Recent breakthroughs in the mass production of inexpensive, highly immersive lightweight stand alone VR systems and augmented reality systems increase the potential for widespread dissemination of VR analgesia for acute and potentially for chronic pain. For example, the U.S. military recently purchased 22 billion dollar’s worth of Microsoft Hololens mixed reality systems (e.g., for training). Expanded research and development of VR analgesia customized for the unique needs of military and VA patients is recommended.

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Virtual Reality to Relieve Pain in Burn Patients Undergoing Imaging and Treatment

Cited by 24 publications

References 52 publications

Virtual Reality for Hypertension in Tooth Extraction: A Randomized Trial

Virtual Reality for Hypertension in Tooth Extraction: A Randomized Trial

Utility of SPECT Functional Neuroimaging of Pain

Immersive Virtual Reality: A Safe, Scalable, Non-opioid Analgesic for Military and Veteran Patients

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