Adjunctive virtual reality pain relief after traumatic injury: a proof-of-concept within-person randomized trial

Abstract

In this study, we hypothesized that immersive virtual reality (VR) environments may reduce pain in patients with acute traumatic injuries, including traumatic brain injuries. We performed a randomized within-subject study in patients hospitalized with acute traumatic injuries, including traumatic brain injury with moderate pain (numeric pain score ≥3 of 10). We compared 3 conditions: (1) an immersive VR environment (VR Blu), (2) a content control with the identical environment delivered through nonimmersive tablet computer (Tablet Blu), and (3) a second control composed of donning VR headgear without content to control for placebo effects and sensory deprivation (VR Blank). We enrolled 60 patients, and 48 patients completed all 3 conditions. Objective and subjective data were analyzed using linear mixed-effects models. Controlling for demographics, baseline pain, and injury severity, we found differences by conditions in relieving pain (F2,75.43 = 3.32, P = 0.042). VR Blu pain reduction was greater than Tablet Blu (−0.92 vs −0.16, P = 0.043), but VR Blu pain reduction was similar to VR Blank (−0.92 vs −1.24, P = 0.241). VR Blu was perceived as most effective by patients for pain reduction (F2,66.84 = 16.28, P < 0.001), and changes in measures of parasympathetic activity including heart rate variability (F2,55.511 = 7.87, P < 0.001) and pupillary maximum constriction velocity (F2,61.41 = 3.50, 1-tailed P = 0.038) echoed these effects. There were no effects on opioid usage. These findings outlined a potential clinical benefit for mollifying pain related to traumatic injuries.

Medical Extended Reality Trials: Building Robust Comparators, Controls, and Sham

“…While there are clearly a host of potential control condition designs, the sham control approach is worth deeper examination due to its popularity and promise. The term "sham" in the XR context has been used to describe a variety of approaches, including headsets with the power off, VR-based simulations of the physical research environment, and 2D content viewed outside of a headset [22][23][24][25][26][27]. Consensus in defining sham versus control in MXR is needed.…”

Using Immersive Virtual Reality Distraction to Reduce Fear and Anxiety before Surgery

“…Nonpharmacologic techniques using distraction are being applied during a growing number of medical procedures to provide anxiolysis with the goal of reducing or eliminating the need for sedative administration [11,12]. Immersive virtual reality (VR) is emerging as a sophisticated and effective non-drug technique for anxiety and pain reduction [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], e.g., during venipuncture [29,30] and even during surgery [31]. fMRI studies show that VR reduces pain-related brain activity, and the amount of pain reduction during VR is comparable to a moderate dose of opioids in analgesic effectiveness [32][33][34].…”