POS0018 INVESTIGATING VIRTUAL IMMERSIVE EXPERIENCES IN THE MANAGEMENT OF CHRONIC PAIN – THE VIPA STUDY (PRELIMINARY RESULTS)

Background:Chronic pain is debilitating and prevalent. Current non-pharmacological management of pain conditions such as Fibromyalgia Syndrome (FMS) are labour intensive to implement and poorly available, especially during the pandemic. There is an urgent need to develop widely adoptable, innovative treatment options for pain cohorts.Virtual reality (VR) provides an innovative therapeutic tool, immersing users within a three-dimensional, interactive virtual environment with use of a head-mounted display (HMD). Beneficial effects of VR have been demonstrated in acute pain1, with limited studies in chronic pain. Given the variation of available VR technologies, it is vital to investigate the impact of different VR characteristics on acceptability in specific chronic pain cohorts.Objectives:This feasibility study aims to establish the acceptability of four different VR technologies in patients with FMS whilst undertaking a single interactive VR experience.Methods:Patients with FMS were recruited through outpatient clinics at the Norfolk and Norwich University Hospital. Baseline questionnaires were used including the McGill pain questionnaire (MPQ-SF), pain visual analogue scale (VAS) and Revised Fibromyalgia Impact Questionnaire (FIQR). Subjective experience questionnaires collected acceptability data with 7-point Likert scale rating questions (strongly disagree to strongly agree). The simulation sickness questionnaire (SSQ) gained side-effect data (total severity score: 0-235). Categorical data were described using frequencies; and continuous data using mean and standard deviation. Likert-scale data were dichotomised (rating ≤3: disagree, rating ≥5: agree).Four VR systems representing the spectrum of commercially available technologies were used (seen in Figure 1). These possess different characteristics including screen resolution, processor speed, weight, strap and controller type. The VR experience used with each headset was co-developed alongside industry partners (Orbital Global). Participants are immersed within a naturalistic environment, situated on a wooden boat travelling slowly along a calm river surrounded by trees and hills. The interactive element involves the user shooting targets that appear using handheld controllers.Results:13 patients with FMS were included (mean age 41.8±15.6, 92.3% female). Most had severe disease (mean FIQR 67.8±14.1) with moderate self-reported pain at baseline (mean MPQ 25.5±8.8, VAS 6.0±1.7). Most had no previous VR exposure (69.2%). 100% of participants agreed that they would be open to using VR for future pain management (mean rating 6.5±0.7) and that they would use VR regularly at home (mean rating 6.5±0.7). VR HMD comfort and enjoyment data are presented in Table 1. Mean ratings of comfort were high across the four HMDs (Gear VR: 4.9±1.7, Oculus Go: 4.5±1.8, Oculus Quest 5.3±1.9, Oculus Rift 6.6±0.5). Mean ratings of enjoyment with each HMD were also high (Gear VR: 5.4±1.6, Oculus Go: 5.4±1.8, Oculus Quest: 5.6±1.9, Oculus Rift S: 6.6±0.5). Low levels of side effects were described with mean SSQ total scores ranging from 20.1±16.8 (Oculus Rift S) to 38.0±23.9 (Gear VR).Conclusion:Preliminary results indicate that FMS patients find VR acceptable, describing high ratings of comfort and enjoyment across the VR HMD spectrum. Side-effect frequency was low, with most settling after HMD removal. All participants were open to future use of VR for home-based pain management.References:[1]Dascal J, Reid M, Ishak WW, Spiegel B, Recacho J, Rosen B, Danovitch I. Virtual reality and medical inpatients: A systematic review of randomized, controlled trials. Innov Clin Neurosci 2017;14(1-2):14-21Table 1.Subjective experience results across VR HMDsMean Likert scale ratings (% agreement: rating ≥5)VR HMDOverall, I found the VR experience using this equipment comfortableOverall, I enjoyed using this VR headsetGear VR4.9±1.7 (62%)5.4±1.6 (77%)Oculus Go4.5±1.8 (54%)5.4±1.8 (75%)Oculus Quest5.3±1.9 (77%)5.6±1.9 (100%)Oculus Rift S6.6±0.5 (100%)6.6±0.5 (100%)Acknowledgements:I would like to acknowledge the contributions of the staff working within the Rheumatology department at the Norfolk and Norwich University Hospital. I would also like to thank and acknowledge our participants for being involved in the study.Disclosure of Interests:Jordan Tsigarides Grant/research support from: Our digital health industry partners (Orbital Global) provided a small financial contribution to support this study., Vanessa Grove: None declared, Dheeraj Sethi: None declared, Jacqueline Chipping: None declared, Susan Miles: None declared, Nicholas Shenker: None declared, Saber Sami: None declared, Alex MacGregor: None declared.

Download Full-text

Virtual Reality as an Adjunct Home Therapy in Chronic Pain Management: An Exploratory Study

JMIR Medical Informatics ◽

10.2196/medinform.7271 ◽

2017 ◽

Vol 5 (2) ◽

pp. e11 ◽

Cited By ~ 30

Author(s):

Bernie Garrett ◽

Tarnia Taverner ◽

Paul McDade

Keyword(s):

Chronic Pain ◽

Virtual Reality ◽

Pain Management ◽

Exploratory Study ◽

Chronic Pain Management ◽

Home Therapy

Download Full-text

The neglected role of distress in pain management: qualitative research on a gastrointestinal ward

Scandinavian Journal of Pain ◽

10.1515/sjpain-2018-0045 ◽

2018 ◽

Vol 18 (3) ◽

pp. 399-407

Author(s):

Gareth Drake ◽

Amanda C. de C. Williams

Keyword(s):

Pain Management ◽

Management Practice ◽

Clinical Staff ◽

University Hospital ◽

Emotional Impact ◽

Junior Doctors ◽

Management Processes ◽

Emergent Structure ◽

The Impact

Abstract Background and aims Pain management for hospital inpatients remains suboptimal. Previously identified barriers to optimal pain management include staff communication difficulties, confusion around pain management roles and a lack of suitable resources for clinical staff. The emotional, relational and contextual complexities of gastrointestinal (GI) pain create particular challenges for frontline clinical staff attempting to implement a biopsychosocial approach to its management. The current study took place over 2 years, comprised an ethnographic and a feedback phase, and aimed to examine pain management processes with clinical staff in order to generate hypotheses and initiatives for improvement. This paper focuses on two overarching themes identified in the ethnographic phase of the study, centred on the neglected role of both staff and patient distress in GI pain management. Methods Grounded theory and thematic analysis methods were used as part of action research, which involves collaborative working with clinical staff. The study took place on a 60 bed GI ward in a university hospital in London. Participants were clinical staff who were either ward-based or involved in the care of particular patients. This latter group included doctors, nurses, psychologists and physiotherapists from the Acute and Complex Pain Teams. Qualitative data on pain management processes was gathered from staff interviews, consultation groups, and observations of patient-staff interactions. Recruitment was purposive and collaborative in that early participants suggested targets and staff groups for subsequent enquiry. Following the identification of initial ethnographic themes, further analysis and the use of existing literature led to the identification of two overarching pain management processes. As such the results are divided into three sections: (i) illustration of initial ethnographic themes, (ii) summary of relevant theory used, (iii) exploration of hypothesised overarching processes. Results Initially, two consultation groups, five nursing staff and five junior doctors, provided key issues that were included in subsequent interviews (n=18) and observations (n=5). Initial ethnographic themes were divided into challenges and resources, reflecting the emergent structure of interviews and observations. Drawing on attachment, psychodynamic and evolutionary theories, themes were then regrouped around two overarching processes, centred on the neglected role of distress in pain management. The first process elucidates the lack of recognition during pain assessment of the emotional impact of patient distress on staff decision-making and pain management practice. The second process demonstrates that, as a consequence of resultant staff distress, communication between staff groups was fraught and resources, such as expert team referral and pharmacotherapy, appeared to function, at times, to protect staff rather than to help patients. Interpersonal skills used by staff to relieve patient distress were largely outside systems for pain care. Conclusions Findings suggest that identified “barriers” to optimal pain management likely serve an important defensive function for staff and organisations. Implications Unless the impact of patient distress on staff is recognised and addressed within the system, these barriers will persist.

Download Full-text

Subjective experience of cognitive function in affective disorders

European Psychiatry ◽

10.1016/s0924-9338(11)71944-7 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 234-234

Author(s):

K. Miskowiak ◽

M. Vinberg ◽

E.M. Christensen ◽

L.V. Kessing

Keyword(s):

Cognitive Function ◽

Cognitive Dysfunction ◽

Subjective Experience ◽

Unipolar Depression ◽

University Hospital ◽

Attention And Memory ◽

Cognitive Difficulties ◽

Affective Symptoms ◽

Patients Experience ◽

The Impact

IntroductionCognitive dysfunction in unipolar depression (UD) and bipolar disorder (BD) may persist into periods of remission and affect psychosocial function. Attention and memory deficits may be more pronounced during remission in BD compared with UD. However, patients’ subjective experience of cognitive difficulties is poorly understood, and it is unclear whether this differs between BD and UD.Aims and objectivesTo examine self-reported cognitive function in remitted patients with BD and UD.MethodsPatients with BD (n = 54) and UD (n = 45) were referred to the outpatient clinic at Department of Psychiatry, Copenhagen University Hospital, following hospital discharge.Affective symptoms and patients’ experience of cognitive symptoms were assessed at their initial consultation at the clinic.ResultsPatients in remission experienced mild to moderate impairment of cognitive function with greatest difficulties in motivation, energy, attention and memory. Subjective experience of cognitive function were similar for BD and UD and were predicted by affective symptoms rather than by diagnosis, age, gender or comorbid alcohol misuse.ConclusionsThe absence of differences between UD and BD in the subjective experience of cognitive difficulties contrasts with evidence of greater objective cognitive dysfunction in BD. This highlights a potential discord between subjective and objective measures of cognitive function. The impact of affective symptoms on the subjectively experienced cognitive difficulties suggests that they reflect mood symptoms rather than objective cognitive deficits. Further investigation of the relation between objective and subjective measures of cognitive function and the influence of affective symptoms is warranted.

Download Full-text

An Integrated Pain Team Model: Impact on Pain-Related Outcomes and Opioid Misuse in Patients with Chronic Pain

Pain Medicine ◽

10.1093/pm/pnaa003 ◽

2020 ◽

Vol 21 (9) ◽

pp. 1977-1984

Author(s):

Carolyn J Gibson ◽

Joseph Grasso ◽

Yongmei Li ◽

Natalie Purcell ◽

Jennifer Tighe ◽

...

Keyword(s):

Health Care ◽

Chronic Pain ◽

Pain Management ◽

Treatment Satisfaction ◽

Subjective Experience ◽

Pain Catastrophizing ◽

Management Strategies ◽

Health Administration ◽

Opioid Misuse

Abstract Objective Biopsychosocial integrated pain team (IPT) care models are being implemented in Veterans Health Administration (VA) and other health care systems to address chronic pain and reduce risks related to long-term opioid therapy, with little evaluation of effectiveness to date. We examined whether IPT improves self-reported pain-related outcomes and opioid misuse. Design Single-group quality improvement study. Setting Large VA health care system. Subjects Veterans with chronic pain (N = 99, 84% male, mean age [SD] = 60 [13] years). Methods Using paired t tests and Wilcoxon matched-pairs signed-ranks tests, we examined pain experience (Brief Pain Inventory, Pain Catastrophizing Scale), opioid misuse (Current Opioid Misuse Measure), treatment satisfaction (Pain Treatment Satisfaction Scale), and pain management strategies among patients with chronic pain before and after three or more IPT encounters. Results After an average (SD) of 14.3 (9) weeks engaged in IPT, patients reported improvement in pain interference (mean [SD] = 46.0 [15.9] vs 40.5 [16.2], P < 0.001), pain catastrophizing (mean [SD] = 22.9 [13.0] vs 19.3 [14.1], P = 0.01), treatment satisfaction (i.e., “very satisfied” = 13.1% at baseline vs 25.3% at follow-up, P = 0.01), and reduced opioid misuse (mean [SD] = 11.0 [7.5] vs 8.2 [6.1], P = 0.01). Patients reported increased use of integrative (i.e., acupuncture, 11% at baseline vs 26% at follow-up, P < 0.01) and active pain management strategies (i.e., exercise, 8% at baseline vs 16% at follow-up, P < 0.01) and were less likely to use only pharmacological pain management strategies after IPT engagement (19% at baseline vs 5% at follow-up, P < 0.01). Conclusions Biopsychosocial, integrated pain care may improve patient-centered outcomes related to opioid misuse and the subjective experience and nonpharmacological self-management of chronic pain.

Download Full-text

Impact of Pharmacist Counselling on Clozapine Knowledge

Schizophrenia Research and Treatment ◽

10.1155/2017/6120970 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Ciara Ní Dhubhlaing ◽

Ailish Young ◽

Laura J. Sahm

Keyword(s):

Side Effects ◽

Patient Information ◽

Side Effect ◽

Information Sources ◽

Knowledge Score ◽

University Hospital ◽

Patient Knowledge ◽

Specific Knowledge ◽

The Impact ◽

Improve Patient

Clozapine is the only antipsychotic with evidence for efficacy in treatment of resistant schizophrenia but it carries a high side effect burden. Patient information is provided but may be poorly retained. This study aims to examine the impact of pharmacist counselling upon patient knowledge of clozapine. Outpatients, aged 18 years and over, attending St. Patrick’s University Hospital, Dublin, participated in this study between June and August 2015. The intervention consisted of pharmacist counselling on two occasions one month apart. Knowledge was assessed using a 28-point checklist devised from the currently available clozapine patient information sources, at baseline and after each counselling session. Ethics approval was obtained. Twenty-five participants (40% female; mean age 45.1 years, SD 9.82; 64% unemployed, 28% smokers) showed an improvement in knowledge scores of clozapine from baseline to postcounselling on each occasion with an overall improvement in knowledge score, from baseline to postcounselling at one month, of 39.43%; p<0.001. This study adds to the evidence that interventions involving pharmacist counselling can improve patient knowledge, whilst the specific knowledge gained relating to recognition of side effects may help patients towards more empowerment regarding their treatment.

Download Full-text

Zoo Therapy for Alzheimer’s Disease with Real-Time Speech Instruction and Neurofeedback System

10.3233/faia210079 ◽

2021 ◽

Author(s):

Yan Ai ◽

Hamdi Ben Abdessalem ◽

Claude Frasson

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Virtual Reality ◽

Real Time ◽

Positive Impact ◽

Negative Emotions ◽

Animal Therapy ◽

Preliminary Results ◽

Emotional Value ◽

The Impact

There is an increasing number of people with Alzheimer’s disease. Negative emotions are not only one of the symptoms of AD, but also the accelerator of the disease. Animal therapy can have a positive impact on the negative emotions of patients, but it has strict requirements for both environments and animals. In this study, we aim to explore the effectiveness of using virtual animals and their impact on the reduction of patients’ negative emotions to improve the user’s cognitive functions. This approach has been implemented in the Zoo Therapy project, which presents an immersive 3D virtual reality animal environment, where the impact on the patient’s emotion is measured in real-time by using electroencephalography (EEG). In addition to creating highly realistic virtual animals, the innovation of Zoo Therapy is also in its communication mechanism as it implements bidirectional human-computer interaction supported by 3 interaction methods: 3D buttons, speech instruction, and Neurofeedback. Patients can actively interact with virtual animals through 3D buttons or speech instructions. The Neurofeedback system will guide the animal to actively interact with the patients according to their real-time emotional changes to reduce their negative emotions. Experiments and preliminary results show that it is possible to interact with virtual animals in Zoo Therapy, and the Neurofeedback system can intervene in Zoo VR environment when the emotional value goes down and might reduce patients’ negative emotions.

Download Full-text

Randomized controlled trial of behavioral skills-based virtual reality (VR) for chronic low back pain: Study protocol for self-administered at-home VR therapy (Preprint)

10.2196/preprints.25291 ◽

2020 ◽

Author(s):

Laura Garcia ◽

Beth Darnall ◽

Parthasarathy Krishnamurthy ◽

Ian Mackey ◽

Josh Sackman ◽

...

Keyword(s):

Chronic Pain ◽

Randomized Controlled Trial ◽

Virtual Reality ◽

Low Back Pain ◽

Back Pain ◽

Pain Management ◽

Controlled Trial ◽

Low Back ◽

Behavioral Skills ◽

Randomized Controlled

BACKGROUND Chronic pain is one of the most common and debilitating health conditions. Treatments for chronic low back typically focus on biomedical treatment approaches. While psychosocial treatments exist, multiple barriers prevent broad access. There is a significant unmet need for integrative, easily accessible, non-opioid solutions for chronic pain. Virtual reality (VR) is an immersive technology allowing innovation in the delivery of behavioral pain treatments. Behavioral skills-based VR is effective at facilitating pain management and reducing pain-related concerns. Continued research on these emerging approaches is needed. OBJECTIVE In this randomized controlled trial, we seek to test the efficacy of a self-administered behavioral skills-based VR program as a non-pharmacological home-based pain management treatment for people with chronic low back pain (cLBP). METHODS We will randomize 180 individuals with cLBP to one of two VR programs: (1) EaseVRx (eight-week skills-based VR program); or (2) Sham VR (control condition). All participants will receive a virtual reality headset to minimize any biases related to the technology’s novelty. The Sham VR group had 2-D neutral content in a 3-D theater-like environment. Our primary outcome is average pain intensity and pain-related interference with activity, stress, mood, and sleep. Our secondary outcomes include patient-reported physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, health utilization, medication use, and user satisfaction. We hypothesize superiority for the skills-based VR program in all of these measures compared to the control condition. Team statisticians blinded to treatment assignment will assess outcomes up to 6 months post-treatment using an approach suitable for the longitudinal nature of the data. RESULTS The study was approved by IRB on July 2, 2020. The protocol (NCT04415177) was registered on May 27, 2020. Recruitment for this study was completed in July 2020 and data collection will remain active until March 2021. In total, 186 participants were recruited. Multiple manuscripts will be generated from this study. The primary manuscript will be submitted for publication in the winter of 2020. CONCLUSIONS Effectively delivering behavioral treatments in VR could overcome barriers to care and provide scalable solutions to chronic pain’s societal burden. Our study could help shape future research and development of these innovative approaches. CLINICALTRIAL ClinicalTrials.gov, NCT04415177. https://clinicaltrials.gov/ct2/show/NCT04415177

Download Full-text

USING VIRTUAL REALITY FOR PAIN MANAGEMENT IN CHILDREN

Ulyanovsk Medico-biological Journal ◽

10.34014/2227-1848-2020-4-19-29 ◽

2020 ◽

pp. 19-29

Author(s):

N.S. Bofanova ◽

E.V. Petrova ◽

V.B. Kalistratov ◽

E.N. Nesterenko ◽

D.I. Chizh

Keyword(s):

Virtual Reality ◽

Pain Management ◽

Acute Pain ◽

Pain Syndrome ◽

Reality Therapy ◽

Medical Procedures ◽

Intravenous Injections ◽

Scientific Papers ◽

Pharmacological Method ◽

The Impact

Virtual reality is a relatively new tool for human-computer interaction. A person becomes an active participant in a virtual world. Virtual reality has quickly become the research subject in various medical fields. For example, today many medical procedures are accompanied by severe pain syndrome and require pain relievers. Virtual reality as an effective non-pharmacological means of reducing pain may become a new way of pain management. Currently, there is not enough scientific papers on the efficacy of the method, which has become the reason for this literature review. The goal of the paper is to analyze electronic databases and scientific literature on the topic over the past 5 years (from 2014 to 2019). Virtual reality has been used to reduce pain in children (4 to 17 years old) in the following medical procedures: intravenous injections, care for burn wounds, wound dressing, drug blockade, vaccination, and acute pain syndrome. The results obtained show that virtual reality is an effective non-pharmacological method of pain management. However, there are still some unresolved questions on the interaction between virtual exposure and some pain killers. Moreover, it is also unclear what is more preferable: the initial use of virtual reality therapy followed by a standard therapy, or vice versa. Conclusion. More research is needed to understand the impact of virtual reality in pediatrics on both acute pain and chronic pain. Keywords: virtual reality, pain syndrome, pediatrics. Виртуальная реальность – относительно новый инструмент взаимодействия человека с компьютером, когда человек становится активным участником виртуального мира. Виртуальная реальность быстро стала предметом исследования в разных медицинских областях. Так, например, сегодня многие медицинские процедуры сопровождаются выраженным болевым синдромом и требуют применения обезболивающих препаратов. Новым направлением в обезболивании может стать применение виртуальной реальности как эффективного нефармакологического средства уменьшения болевого синдрома. В настоящее время опубликовано недостаточно научных работ об эффективности этого метода, что стало причиной проведения данного литературного обзора. Цель – анализ электронных баз данных и научной литературы за последние 5 лет (с 2014 по 2019 г.). Виртуальная реальность использовалась для уменьшения болевого синдрома у детей (от 4 до 17 лет) при следующих процедурах: внутривенные инъекции, уход за ожоговыми ранами, перевязка ран, проведение медикаментозных блокад, вакцинация, а также при остром болевом синдроме. Результаты проанализированных исследований показывают, что виртуальная реальность является эффективным нефармакологическим методом уменьшения болевого синдрома. Однако остаются нерешенными вопросы о взаимодействии между виртуальным воздействием и некоторыми обезболивающими препаратами, также неясно, что является более предпочтительным: первоначальное применение терапии с помощью виртуальной реальности, а затем без нее или наоборот. Выводы. Необходимо проведение дополнительных исследований для лучшего понимания влияния виртуальной реальности в педиатрии как на острый болевой синдром, так и на хроническую боль. Ключевые слова: виртуальная реальность, болевой синдром, педиатрия.

Download Full-text

Utilising Virtual Reality in Pain Management: A Systematic Review

Medicine & Health ◽

10.17576/mh.2021.1602.04 ◽

2021 ◽

Vol 16 (2) ◽

pp. 52-71

Author(s):

Faiz Daud ◽

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Virtual Reality ◽

Pain Management ◽

Acute Pain ◽

Burn Injury ◽

Behavioral Therapy ◽

Chronic Neck Pain ◽

Complementary Therapy ◽

Orthopedic Diseases

Virtual reality (VR) offers patient with a drug free supplement, an alternative or complementary therapy to traditional pain management. VR technology allowing its use in a wide variety of settings in the medicine world. So, we would like to evaluate the current existing evidence supporting VR in pain management. We conducted a systematic review of interventional and observational studies that examined VR applications in pain management between 2010 and 2019. We used Scopus databases, PubMed, Web of Science, Ovid MEDLINE and EBSCOhost to identify the studies using keywords “patient”, “virtual reality”, “medicine” and “pain management”. Data was obtained by two investigators and agreement was reached with the involvement of a third and fourth investigator. Narrative synthesis for all research was done. A total of 451 citations were identified, among which 12 studies met the criteria for inclusion. Studies involve various countries with participant age ranging from 6 to 75 years old. Studies were small, employed different design, instrument and measure for outcome. Studies addressed experimental, acute and chronic pain with four categories of condition which are burn injury, orthopedic diseases and chronic headache. VR was effective during the procedure in experimental and acute pain management. Majority of studies involving VR in painful physical rehabilitation therapy found VR reduced chronic pain and some provide evidence of lasting analgesia effect of VR after therapy. The usage of VR in chronic pain in term of psychological and cognitive behavioral therapy (CBT) showed improvement of positive mood, emotional and motivation that could lead to improvement of quality of life. VR also useful to elicit findings during painful cervical kinematics assessment in chronic neck pain. VR is a promising technology to be applied in managing chronic and acute pain. Some research showed that VR usage is able to provide lasting effect of analgesia even after VR session. However, there is a need for long term, larger sample sizes and well controlled studies to show clinical and cost-effectiveness for this technology to be used in clinical settings.

Download Full-text