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13 Articles in Volume 18, Issue #1
Applying a Collaborative Care Model to the Treatment of Chronic Pain and Depression
Assessing the Pain Triangle
Emerging Technologies in Rehabilitation Medicine
Honoring Dr. Forest Tennant’s 50-Plus Years in Pain Management
Is There a Chronic Pain Personality Profile?
Managing Musculoskeletal Pain in Endurance Athletes
Managing Perioperative Pain
Nonparenteral Oxytocin, Erythromelalgia...Letters from the Minds of Peers and Patients
OSKA PEMF Pain Relief Device: A Mini Review Trial
Patient Communication & Opioid Prescribing in the New Year
VR Gaming as a Tool for Pain Relief
What Opioid Shopping Means for Pain Practitioners
Would Patients Benefit from a Glucosamine/Chondroitin Supplement to Manage Knee Osteoarthritis Pain?

VR Gaming as a Tool for Pain Relief

The next evolution of virtual reality may provide patients experiencing chronic pain with just enough distraction to feel like themselves again.

In the effort to find new and effective nonpharmacological treatments for chronic pain, virtual reality and gaming continue to add options to the practitioner’s evolving toolbox. Such technologies have proven effective in relieving certain acute and procedural pains, and they may soon have application for chronic pain conditions as well.

Lessening Procedural Pain & Anxiety

At Children’s Hospital Los Angeles, researchers found that a virtual reality (VR) game designed to manage pain and reduce anxiety proved successful among a group of patients aged 10 to 21 as they underwent a blood draw.1 The study included 143 subjects whose diagnoses included cystic fibrosis, sickle anemia, cancer, and other acute and chronic illnesses.

One group received the standard of care: a topical anesthetic cream or spray at the site of the draw, with a movie playing in the background. The second group received the standard of care, plus the ability to play a virtual reality game called Bear Blast (AppliedVR, Los Angeles). To play the game, patients wore VR goggles linked to cellphones and tried to launch red balls at bears and other objects by looking at them through the virtual environment. The year-long, randomized controlled trial concluded that virtual reality significantly reduced acute procedural pain and anxiety in patients compared to those receiving only the standard of care. Patients with higher anxiety sensitivity achieved greater results.

While the study focused on a simple procedure in younger patients, it has the potential to have broader applications in pain care, including among a wider demographic. “Our study involved using virtual reality to treat procedural pain management,” Jeffrey I. Gold, PhD, said. Dr. Gold is an attending physician/clinical professor of anesthesiology at the Keck School of Medicine, University of Sothern California, and director of the Pediatric Pain Management Clinic at Children’s Hospital Los Angeles. “Virtual reality works on pain by drawing the user’s attention away from medical procedures and into the virtual world. In the future, VR environments may target specific acute and chronic pain conditions in children. Some are already doing this with adults,” he said.

Pain Intensity, Catastrophizing, and Function

A more recent (2020) study led by Beth Darnall, PhD, at Stanford University found "a significant reduction in pain outcomes" over a 21-day trial period of just under 100 adults with self-reported chronic low back or fibromyalgia using a skills-based VR program (including CBT, relaxation, and mindfulness) compared to using a similar audio-only VR program.2

Pain catastrophizing lessened and pain self-efficacy (ie, confidence in the ability to carry out daily activities) improved in both groups. The team concluded, "VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain."

When Fun Leads to Pain Relief

As the technology’s usage evolves from entertainment purposes to healthcare impact, pain care physicians may soon find VR settings useful in their daily practice. According to Gayatri Devi, MD, a neurologist at Lenox Hill Hospital in New York City who specializes in memory disorders and pain management, “Research underlines the fact that pain is always felt in the brain and not in the extremity or body part where the cause might be. Distraction either with virtual reality or with any other engaging task that requires user participation will lead to less perception of pain at the central brain level,” she said.

In terms of software capability to treat chronic pain, “It is a little more challenging, but it has a lot of potential,” said Hunter Hoffman, PhD, a cognitive psychology/research scientist at the University of Washington. He helped to create SnowWorld at the university in collaboration with the Harborview Burn Center; it was the first VR pain relief application on the market and is currently used in Shriners Hospitals for Children in Galveston, Texas.

Hoffman and his associate, David R. Patterson, PhD, professor of psychology at the University of Washington School of Medicine, co-originated the technique of using immersive VR for pain distraction in the 1990s.3 In their studies, severe burn patients have typically reported 35 to 50% reductions in pain while engrossed in SnowWorld VR during painful procedures, such as exercises that help maintain elasticity of the burned skin as it heals.

In lab studies with healthy volunteers, fMRI brain scans showed large reductions in pain-related brain activity during VR – objective evidence of VR analgesia. Currently, Patterson and Walter Meyer, MD, director of Shriners Hospital s Psychology and Psychiatry Services, are the principal investigators of a National Institutes of Health grant exploring the use of SnowWorld in procedural pain relief on a sample group of children with unusually large, severe burns at Shriners Hospitals. Researchers are gauging the technology’s impact during wound cleaning and expect to complete the study in mid-2019.

Using Technology to Track Distraction

Another innovative pain control technology uses brain wave analysis to track pain levels via tablet. The AccendoWave System promises to provide “discomfort detection, monitoring, and reporting devices for the reduction of human suffering,” Martha Lawrence, CEO and co-founder of the company, said. AccendoWave is able to assess patient discomfort levels using electroencephalography (EEG) technology via a headband, while a tablet-based active discomfort management platform allows patients to report on their pain level.

Approximately 20,000 patients have used the technology, which was piloted among 1,000 patients over six months in 2016 with 81% of 334 completed surveys reporting improved comfort levels,4,5 at Southern Hills Hospital in Las Vegas and other outpatient facilities, including surgery centers. Lawrence adds that the algorithm has been used by patients in the emergency room setting as well as in the hospital’s departments of oncology, orthopedics, neurology, and in the observation, and labor and delivery rooms, with an 84% effectiveness rate. “Patients say that the AccendoWave program ‘understands’ their pain and provides the kind of individualized content they want to see,” she said.

Findings to date show that the program “can be helpful to relieve anxiety and stress as well as pain,” Lawrence said. “We also hope to modify and alter the technology so it would be appropriate for a home setting.”

The AppliedVR developers also hope to bring their technology from the clinical setting into patients’ homes to help them manage conditions such as chronic pain, according to the company’s president, Josh Sackman. Currently, the platform is being used in more than 100 healthcare settings, including hospitals, surgery centers, burn centers, and infusion centers.

Future Impact

Side effects of virtual reality usage may include “dizziness, lightheadedness, and simulator sickness,” more so among adult populations, said Dr. Devi. Otherwise, “there is no downside,” she added. It may be some time before virtual reality is applied in a primary care setting, however, as studies to date have been small, said Dr. Devi. “The data needs to be replicated before we can talk about translating it into clinical practice.” Further questions need to address whether the technology is most effective in a clinical or home setting, and for how long patients may need to engage with the games to achieve relief.


Last updated on: July 14, 2020
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