Virtual Reality as an Adjunctive Non-pharmacologic Analgesic for Acute Burn Pain During Medical Procedures

Abstract

Introduction Excessive pain during medical procedures is a widespread problem but is especially problematic during daily wound care of patients with severe burn injuries. Methods Burn patients report 35–50% reductions in procedural pain while in a distracting immersive virtual reality, and fMRI brain scans show associated reductions in pain-related brain activity during VR. VR distraction appears to be most effective for patients with the highest pain intensity levels. VR is thought to reduce pain by directing patients’ attention into the virtual world, leaving less attention available to process incoming neural signals from pain receptors. Conclusions We review evidence from clinical and laboratory research studies exploring Virtual Reality analgesia, concentrating primarily on the work ongoing within our group. We briefly describe how VR pain distraction systems have been tailored to the unique needs of burn patients to date, and speculate about how VR systems could be tailored to the needs of other patient populations in the future.

Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD

“…Although in recent times the popular media has lavishly reported on VR’s potential impact on all elements of our evolving digital culture, and has created the impression that VR is a novel technology, the reality is that VR is not a new concept, and many of its developmental roots are traceable to the 1980s and 1990s (Schnipper et al, 2015). Moreover, since the 1990s a significant scientific literature has evolved, almost under the radar, reporting many positive outcomes across a range of clinical applications that have leveraged the assets provided by VR (Botella, Serrano, Baños, & García-Palacios, 2015; Dascal et al, 2017; Freeman et al, 2017; Hoffman et al, 2011; Howard, 2017; Maples-Keller, Yasinski, Manjin, & Rothbaum, 2017; Morina, Ijntema, Meyerbröker, & Emmelkamp, 2015; Rizzo, 1994; Rizzo et al, 2006; Rizzo, Buckwalter, & van der Zaag, 2002, 2015a; Rizzo et al, 2010, in press, 2017, 2015b; Slater & Sanchez-Vives, 2016). Within that context, the present paper will summarize the ways that researchers and clinicians have employed VR to create relevant simulations that can be applied to the prevention, assessment, and treatment of PTSD.…”

“…This recognition of the potential impact of VR technology has led to the emergence of a significant, albeit still maturing, research literature that documents the many clinical and research targets where VR can add value relative to traditional assessment and intervention methods. A short list of the areas where Clinical VR has been usefully applied includes fear reduction in persons with specific phobias (Morina et al, 2015; Opris et al, 2012; Parsons & Rizzo, 2008; Powers & Emmelkamp, 2008), treatment for posttraumatic stress disorder (Beidel, Frueh, Neer, & Lejuez, 2017; Botella et al, 2015; Difede & Hoffman, 2002; Difede et al, 2007, 2014; Maples-Keller et al, 2017; McLay et al, 2011; Rizzo et al, 2010, 2013, 2017; Rothbaum, Hodges, Ready, Graap, & Alarcon, 2001; Rothbaum et al, 2014), cue-exposure for addiction and relapse prevention (Hone-Blanchet, Wensing, & Fecteau, 2014; Yoon et al, 2014), depression (Falconer et al, 2016), paranoid delusions (Freeman et al, 2016), discomfort reduction in cancer patients undergoing chemotherapy (Schneider, Kisby, & Flint, 2010), acute pain reduction during wound care and physical therapy with burn patients (Hoffman et al, 2011), other painful procedures (Gold et al, 2006; Mosadeghi, Reid, Martinez, Rosen, & Spiegel, 2016), body image disturbances in patients with eating disorders (Riva, 2011), navigation and spatial training in children and adults with motor impairments (John, Pop, Day, Ritsos, & Headleand, 2017), functional skill training and motor rehabilitation in patients with central nervous system dysfunction (e.g. stroke, traumatic brain injury, spinal cord injury, cerebral palsy, multiple sclerosis, etc.)…”

PainDroid: an android-based virtual reality application for pain assessment

“… The majority of the research efforts have focused on clinic-based applications running on PC-based platforms [18][19][20][21][22][23][24][25][26][27][28][29][30], with only a limited number of studies paying attention to the need for mobile pain assessment. In fact, it is surprising that very few (if any) have been 6 built and ported to mobile platforms.…”

Applications of Virtual Reality Technology in Brain Imaging Studies

“…"Driving" could be performed using a virtual environment [49][50][51][52][53][54][55][56][57][58][59] or a nonvirtual environment [73]. Pain distractors could comprise virtual reality protocols [75][76][77] or 2D equivalents. Would the use of virtual reality 3D versus conventional 2D versions of task stimuli lead to observable differences in brain responses?…”

“…The use of virtual reality as an adjunct treatment for control of pain has been proposed. One hypothesis is that virtual reality will engage attention and therefore distract or decrease attention to pain [75]. Virtual reality approaches to treatment of pain have been assessed with fMRI using normal volunteers.…”