Virtual Reality interventions for acute and chronic pain management

Ahmadpour, Naseem; Randall, Hayden; Choksi, Harsham; Gao, Antony; Vaughan, Christopher W.; Poronnik, Philip

doi:10.1016/j.biocel.2019.105568

Cited by 164 publications

(106 citation statements)

References 38 publications

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“…The analgesic effects brought about by this immersive VR experience to our patient made it possible to reduce the doses of IV-PCA fentanyl by 25~75%, which alleviated the opioid-induced respiratory depression. This case study not only confirms previous reports showing the effectiveness of VR to alleviate pain during wound care and physical therapy in patients with burns [11,12], but also illustrates the feasibility of using a VR analgesic to manage pain in a patient with ACS.…”

Section: Resultssupporting

confidence: 87%

“…In the current case, as primary or opioid-induced hyperalgesia may have occurred, it was necessary to reduce the dose of fentanyl as quickly as possible. Thus, it is of great clinical significance that a VR analgesic proved effective in alleviating the pain in the late phase of a patient with ACS treated with fasciotomy, thereby reducing the need for opioids [12].…”

Section: Resultsmentioning

confidence: 99%

“…Considering the adverse effects of opioids and the serious negative social impact of widespread opioid addiction that originates from the misuse of prescription drugs [21], alternative means of pain control that can reduce opioid usage are of great clinical importance. VR is a promising nonpharmacological means to replace and/or complement opioids [12]. It has been shown in healthy individuals that the thermal stimulation of VR confers additive analgesic effects to opioid treatment in alleviating pain [22].…”

Section: Resultsmentioning

confidence: 99%

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Virtual reality as a non-pharmacologic analgesic for fasciotomy wound infections in acute compartment syndrome: a case report

et al. 2020

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Background: Fasciotomy is a life-saving procedure to treat acute compartment syndrome, a surgical emergency. As fasciotomy dramatically improves wound pain, it should be performed as soon as possible. Moreover, delays in the use of fasciotomy can increase the rate of wound infections. Once the fasciotomy wound is infected, pain control is achieved via the long-term use of opioids or anti-inflammatory analgesics. However, the administration of high doses of opioids may cause complications, such as respiratory depression, over-sedation, and constipation. Therefore, treatment methods other than narcotic administration should be established to better manage the pain caused by fasciotomy wound infections. Virtual reality has recently been introduced in analgesic therapy as a replacement, or complement, to conventional pharmacological treatments. Its use has been extensively studied in the pain management of patients with burns. An increasing number of painful conditions are being successfully treated with virtual reality. Here, we report a case of acute compartment syndrome complicated by fasciotomy wound infection. Case presentation: A 40-year-old Japanese man suffering from acute compartment syndrome of his leg due to a car accident trauma was treated with a fasciotomy to decompress intra-compartmental pressure and restore tissue perfusion, and admitted to an intensive care unit. Unfortunately, as the open fasciotomy wound was complicated by infection, he complained of hyperalgesia and severe pain during wound debridement. He was therefore given acetaminophen and high-dose intravenous patient-controlled analgesic fentanyl (35 μg/kg per day) to reduce the pain. Despite these efforts, the pain was poorly controlled and opioid-induced side effects such as respiratory depression were observed. An immersive virtual reality analgesic therapy aimed at distraction and relaxation was used and effectively alleviated the pain. Three sessions of virtual reality analgesic therapy over 2 days produced sustainable analgesic effects, which led to a 25-75% dose reduction in fentanyl administration and the concomitant alleviation of respiratory depression.

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Section: Resultssupporting

confidence: 87%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Virtual reality as a non-pharmacologic analgesic for fasciotomy wound infections in acute compartment syndrome: a case report

et al. 2020

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“…Our patients were administered two separate treatment conditions, GM and BFD, and we found that pain was significantly reduced immediately following both conditions with moderate effect sizes, and we did not find a significant difference between those two conditions. Other studies and reviews have found similar trends in immediate reduction of acute and chronic pain post‐VR experience .…”

Section: Discussionsupporting

confidence: 59%

Virtual Reality–Based Biofeedback and Guided Meditation in Rheumatology: A Pilot Study

Venuturupalli

Chu²,

Vicari³

et al. 2019

ACR Open Rheumatology

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Objective. As technology continues to improve, it plays an increasingly vital role in the practice of medicine. This study aimed to assess the feasibility of the implementation of virtual reality (VR) in a rheumatology clinic as a platform to administer guided meditation and biofeedback as a means of reducing chronic pain.Methods. Twenty participants were recruited from a rheumatology clinic. These participants included adults with physician-diagnosed autoimmune disorders who were on a stable regimen of medication and had a score of at least 5 on the pain Visual Analog Scale (VAS) for a minimum of 4 days during the prior 30 days. VAS, part of most composite outcome measurements in rheumatology, is an instrument used to assess pain that consists of a straight line with the endpoints ranging from "no pain at all" and "pain as bad as it could be." Patients were randomized into two groups that differed in the order in which they experienced the two VR modules. One module consisted of a guided meditation (GM) environment, whereas the other module consisted of a respiratory biofeedback (BFD) environment. Data on pain and anxiety levels were gathered before, during, and after the two modules.Results. The three most common diagnoses among participants were rheumatoid arthiritis (RA), lupus, and fibromyalgia. There was a significant reduction in VAS scores after BFD and GM (P values = 0.01 and 0.04, respectively). There was a significant reduction in Facial Anxiety Scale after the GM compared with the BFD (P values = 0.02 and 0.08, respectively).Conclusion. This novel study demonstrated that VR could be a feasible solution for the management of pain and anxiety in rheumatology patients. Further trials with varying treatment exposures and durations are required to solidify the viability of VR as a treatment option in rheumatology clinics.

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“…There has been increasing interest in assessing its analgesic potential in various fields of medicine, especially since VR has demonstrated clinical efficacy in pain reduction whilst being well-tolerated by patients in a variety of settings e.g. burn wound dressing, venepuncture, and dental treatments [11][12][13][14][15][16] 13,18 . To date, however, there has been no investigation of the use of VR in women undergoing ECV.…”

mentioning

confidence: 99%

A randomised controlled trial to assess the feasibility of utilising virtual reality to facilitate analgesia during external cephalic version

Smith

Warty

Kashyap

et al. 2020

Sci Rep

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external cephalic version (ecV) is associated with a moderate degree of pain. Virtual reality (VR) is a technology that has shown promise in offering procedural analgesia. We undertook a clinical pilot to assess the viability of VR to reduce pain during ECV. In an open randomised controlled trial (RCT), we randomised 50 women to either VR or standard care each (25 per group). Women receiving VR were administered VR content (Skylights) via a headset. Pre-and post-procedural measures of pain, anxiety, device experience and vital signs were measured. There were no significant differences between groups (VR/no VR) in pain scores (60.68 vs 49.76; p = 0.2), ECV success rates (80% vs 76%; p = 0.7) or anxiety levels. The women receiving VR had a significantly higher anticipation of pain pre-procedurally (70.0 vs 50.0; p = 0.03). 20 (80%) of the VR women indicated that they would use VR again and 22 (88%) indicated they would recommend it to a friend having ECV. There were no significant differences between groups for side effects encountered or changes in vital signs. We have shown that using VR during ecV is feasible and appears safe. our results inform the design of future Rcts. open Scientific RepoRtS | (2020) 10:3141 | https://doi.

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Virtual Reality interventions for acute and chronic pain management

Cited by 164 publications

References 38 publications

Virtual reality as a non-pharmacologic analgesic for fasciotomy wound infections in acute compartment syndrome: a case report

Virtual reality as a non-pharmacologic analgesic for fasciotomy wound infections in acute compartment syndrome: a case report

Virtual Reality–Based Biofeedback and Guided Meditation in Rheumatology: A Pilot Study

A randomised controlled trial to assess the feasibility of utilising virtual reality to facilitate analgesia during external cephalic version

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