Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study

Abstract

Background In the field of pain, virtual reality (VR) technology has been increasingly common in the context of procedural pain management. As an interactive technology tool, VR has the potential to be extended beyond acute pain management to chronic pain rehabilitation with a focus on increasing engagement with painful or avoided movements. Objective We outline the development and initial implementation of a VR program in pain rehabilitation intervention to enhance function in youth with chronic pain. Methods We present the development, acceptability, feasibility, and utility of an innovative VR program (Fruity Feet) for pediatric pain rehabilitation to facilitate increased upper and lower extremity engagement. The development team was an interdisciplinary group of pediatric experts, including physical therapists, occupational therapists, pain psychologists, anesthesiologists, pain researchers, and a VR software developer. We used a 4-phase iterative development process that engaged clinicians, parents, and patients via interviews and standardized questionnaires. Results This study included 17 pediatric patients (13 female, 4 male) enrolled in an intensive interdisciplinary pain treatment (IIPT) program, with mean age of 13.24 (range 7-17) years, completing a total of 63 VR sessions. Overall reports of presence were high (mean 28.98; max 40; SD 4.02), suggestive of a high level of immersion. Among those with multisession data (n=8), reports of pain (P<.001), fear (P=.003), avoidance (P=.004), and functional limitations (P=.01) significantly decreased. Qualitative analysis revealed (1) a positive experience with VR (eg, enjoyed VR, would like to utilize the VR program again, felt VR was a helpful tool); (2) feeling distracted from pain while engaged in VR; (3) greater perceived mobility; and (4) fewer clinician-observed pain behaviors during VR. Movement data support the targeted impact of the Fruity Feet compared to other available VR programs. Conclusions The iterative development process yielded a highly engaging and feasible VR program based on qualitative feedback, questionnaires, and movement data. We discuss next steps for the refinement, implementation, and assessment of impact of VR on chronic pain rehabilitation. VR holds great promise as a tool to facilitate therapeutic gains in chronic pain rehabilitation in a manner that is highly reinforcing and fun.

Leveraging Virtual Reality and Augmented Reality to Combat Chronic Pain in Youth: Position Paper From the Interdisciplinary Network on Virtual and Augmented Technologies for Pain Management

“…The overall goal was to improve function and reduce the fear of pain. The initial implementation of Fruity Feet VR tested the acceptability and feasibility of facilitating increased upper and lower extremity engagement [ 29 ]. This platform was simultaneously tested with an inpatient population during physical therapy sessions with large effects on movement observed in VR compared with the standard of care physical therapy (Caruso et al, unpublished data, August 2019).…”

“…These include physical movement, energy expenditure, physiology, and immersion. In the context of pain rehabilitation, increasing movement is a highly relevant outcome that can be measured in real time [ 29 ]. An added consideration is the frequency of assessment, as it is likely that data collection may range from continual, session-contingent, daily, or milestone-based (eg, start of treatment and discharge).…”

Mindfulness-Based Virtual Reality Intervention for Children and Young Adults with Inflammatory Bowel Disease: A Pilot Feasibility and Acceptability Study

“…When considering delivery methods for brief MBIs among pediatric IBD populations, Virtual Reality (VR) platforms have great potential. VR’s increasing availability in children’s hospitals, high acceptability among children, and immersive nature [ 28 , 29 , 30 ] all suggest it could provide an excellent platform to deliver engaging MBIs. Past research in adult populations has demonstrated that MBIs delivered via VR can help actively capture a person’s attention and support their sense of presence in the mindfulness experience (via 3D computer generated environment) [ 31 , 32 , 33 ].…”

Leveraging Virtual Reality and Augmented Reality to Combat Chronic Pain in Youth: Position Paper From the Interdisciplinary Network on Virtual and Augmented Technologies for Pain Management (Preprint)

“…These include physical movement, energy expenditure, physiology, and immersion. In the context of pain rehabilitation, increasing [29]. An added consideration is the frequency of assessment, as it is likely that data collection may range from continual, session-contingent, daily, or milestone-based (eg, start of treatment and discharge).…”