Virtual Reality after Surgery—A Method to Decrease Pain After Surgery in Pediatric Patients

Specht, Brian J.; Buse, Caroline; Phelps, Janey R.; Phillips, Michael; Chiavacci, Sarah; Harrell, Lauren; Nelson, Jacob M.; Poulos, Katherine E.; Li, Quefeng; Liu, Yutong; Lupa, M. Concetta

doi:10.1177/00031348211032204

Cited by 8 publications

(19 citation statements)

References 13 publications

(14 reference statements)

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“…While there is a rise in studies evaluating the use of VR for procedural anxiety and pain control, only a few studies have aimed to evaluate the use of VR after surgery . Specht et al performed a randomized clinical trial and found that VR was associated with reduced postoperative pain scores compared with tablet use among pediatric patients. Olbrecht et al also found VR to reduce pain and anxiety among pediatric patients after surgery.…”

Section: Discussionmentioning

confidence: 97%

“…Thus, there is a role for nonpharmacologic adjuncts to pain control. The application of VR in health care is steadily expanding, including procedural distraction, anxiety reduction, and pain control . One theory is that diversion of attention to pain through distraction may provide a slower response to pain signals .…”

Section: Discussionmentioning

confidence: 99%

“…In the general inpatient setting, VR use has shown to be feasible and associated with pain reduction compared with a 2-dimensional (2D) control . However, there has been limited study of VR in the setting of postoperative pain management . There are different types of VR content that may influence the sensory experience .…”

Section: Introductionmentioning

confidence: 99%

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Effect of Virtual Reality on Pain Management and Opioid Use Among Hospitalized Patients After Head and Neck Surgery

Pandrangi

Shah

Bruening

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEOptimal postoperative pain management is challenging. Virtual reality (VR) provides immersive, 3-dimensional experiences that may improve pain control and reduce reliance on pharmacologic pain management.OBJECTIVE To evaluate use of VR on postoperative pain management after head and neck surgery. DESIGN, SETTING, AND PARTICIPANTSThis prospective, pilot randomized clinical trial was conducted at Oregon Health & Science University from July 2020 to October 2021 and included patients hospitalized after major head and neck surgery. INTERVENTIONS Similar 15-minute interactive gaming experiences (Angry Birds) using an Oculus Quest VR headset (VR intervention) or a handheld smartphone device (control). MAIN OUTCOMES AND MEASURESThe primary outcome was postintervention pain reduction. Pain scores were obtained preintervention, immediately after intervention, and then hourly for 4 hours. Secondary outcomes included changes in opioid use, measured as milligram morphine equivalents (MMEs), and patient experiences with their intervention using 5-point Likert scales. RESULTSOf the 30 patients randomized for inclusion, the final population included 14 patients in the VR cohort and 15 patients in the control cohort; the majority of patients were male (26 of 29 [90%]), and the mean (SD) age was 58.3 (13.8) years. After outlier removal, there were clinically meaningful reductions in postintervention pain among patients in the VR group immediately after intervention (mean difference, −1.42; 95% CI, −2.15 to −0.70; d = 1.50), at 1 hour (mean difference, −0.86; 95% CI, −1.90 to 0.14; d = 0.67), 2 hours (mean difference, −1.07; 95% CI, −2.30 to 0.14; d = 0.69), and 3 hours (mean difference, −1.36; 95% CI, −2.80 to 0.13; d = 0.71) compared with patients in the control group. Patients in the VR group also demonstrated reductions in 4-hour postintervention opioid use compared with 4-hour preintervention opioid use (mean difference, −9.10 MME; 95% CI, −15.00 to −1.27 MME; d = 0.90) and 8-hour postintervention opioid use compared with 8-hour preintervention opioid use (mean difference, −14.00 MME; 95% CI, −25.60 to −2.40 MME; d = 0.94). There were no meaningful differences in subjective patient experiences with their respective interventions. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, VR reduced pain scores and opioid use compared with a control intervention. Virtual reality may be a useful adjunct for postoperative pain management after head and neck surgery.TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04464304

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Effect of Virtual Reality on Pain Management and Opioid Use Among Hospitalized Patients After Head and Neck Surgery

Pandrangi

Shah

Bruening

et al. 2022

JAMA Otolaryngol Head Neck Surg

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“…In one RCT examining digital intervention in breast cancer surgery patients, the treatment group showed significant reduction of time (by 5 days) toward cessation of opioid medications, as compared to the control group (digital health education) ( 13 ). In another RCTs, VR app intervention (as compared to standard iPad use) did not change postoperative pain scores nor opioid consumption in pediatric patients ( 50 ). As discussed below, with more ongoing RCTs studying digital interventions and opioid-based analgesia in pain patients, our results justify near-future SR/MA study to evaluate clinical efficacy of adjunct VR and mobile apps in conjunction with analgesics to improve pain management.…”

Section: Adjunct Digital Interventions For Opioid-based Analgesiamentioning

confidence: 94%

“…Two additional RCTs investigated digital interventions in pain patients taking opioid analgesics, but they did not meet all three inclusion criteria (the comparator was not pharmacological treatment alone) ( 13 , 50 ). In one RCT examining digital intervention in breast cancer surgery patients, the treatment group showed significant reduction of time (by 5 days) toward cessation of opioid medications, as compared to the control group (digital health education) ( 13 ).…”

Section: Adjunct Digital Interventions For Opioid-based Analgesiamentioning

confidence: 99%

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

Giravi

Biskupiak

Tyler

et al. 2022

Front. Digit. Health

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Digital therapeutics (DTx, mobile medical apps, software as a medical device) are rapidly emerging as clinically effective treatments for diverse chronic diseases. For example, the Food and Drug Administration (FDA) has recently authorized a prescription virtual reality (VR) app for treatment of moderate to severe low back pain. The FDA has also approved an adjunct digital therapy in conjunction with buprenorphine for opioid use disorder, further illustrating opportunities to integrate digital therapeutics with pharmacotherapies. There are ongoing needs to disseminate knowledge about advances in digital interventions among health care professionals, policymakers, and the public at large. This mini-review summarizes accumulating clinical evidence of digital interventions delivered via virtual reality and mobile apps to improve opioid-based analgesia. We identified relevant randomized controlled trials (RCTs) using Embase and PubMed databases which reported pain scores with a validated pain scale (e.g., visual analog scales, graphic rating scale, numeric rating scale) and use of a digital intervention in conjunction with opiates. Among identified RCTs, the majority of studies reported improved pain scores in the digital intervention group, as compared to “treatment as usual” group. Our work suggests that VR and mobile apps can be used as adjunct digital therapies for pain management. We discuss these findings in the context of how digital health technologies can transform patient-centered pharmacy care.

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Use of Perioperative Virtual Reality Experiences on Anxiety and Pain: A Randomized Comparative Trial

Pandrangi,

Low,

Slijepcevic

et al. 2023

The Laryngoscope

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ObjectiveTo evaluate the effect of different virtual reality (VR) experiences on perioperative anxiety and pain among patients undergoing head and neck surgery.MethodsProspective, randomized, comparative trial among patients undergoing outpatient head and neck surgery from December 2021 to April 2022 at a single academic institution. Group 1 utilized a preoperative VR gaming experience and a postoperative VR mindfulness experience, while Group 2 utilized the same interventions in the reverse order. Anxiety and pain were measured using visual analog scales (VAS). Primary outcomes were changes in post‐intervention anxiety and pain. Secondary outcomes included vital sign changes and subjective patient experiences using a 5‐point Likert scale.ResultsThere were 32 patients randomized for inclusion, with 16 patients per group. The majority of patients were female (65.6%) and mean (standard deviation) age was 47.3 (16.7) years. After outlier exclusion, there were no differences in post‐intervention preoperative anxiety reduction (Group 1 vs. Group 2, median [IQR]: −12.0 [15] vs. −10.5 [13], p = 0.62). There were minor differences in vital sign changes (p < 0.05). Among the 10 patients in Group 1 and 12 patients in Group 2 who completed postoperative VR use, there were no differences in post‐intervention pain reduction (−8.5 [22.3] vs. −7.5 [19.3], p = 0.95) or vital sign changes (p > 0.05). There were no differences in questionnaire responses, with high satisfaction in both groups (p > 0.05). No adverse events encountered.ConclusionsUse of different VR experiences among patients undergoing outpatient head and neck surgery appears associated with similar reductions in perioperative anxiety and pain.Level of Evidence2 Laryngoscope, 2023

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Virtual Reality after Surgery—A Method to Decrease Pain After Surgery in Pediatric Patients

Cited by 8 publications

References 13 publications

Effect of Virtual Reality on Pain Management and Opioid Use Among Hospitalized Patients After Head and Neck Surgery

Effect of Virtual Reality on Pain Management and Opioid Use Among Hospitalized Patients After Head and Neck Surgery

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

Use of Perioperative Virtual Reality Experiences on Anxiety and Pain: A Randomized Comparative Trial

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