Virtual Reality for Pain Control—Virtual or Real?

Virtual Reality (VR) technology creates a sense of immersion in a virtual environment analogous to the real world. VR has increasingly gained attention for pain management based on current evidence demonstrating its analgesic effects in certain experimental, acute and chronic pain conditions. VR-based interventions shift the users’ attention towards active cognitive processing that can lead to higher pain threshold or tolerance. An understanding of neurobiological mechanisms underlying analgesic effects of VR will definitely facilitate optimal utility of this tool for pain control.

Download Full-text

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

Journal of Medical Internet Research ◽

10.2196/25916 ◽

2021 ◽

Vol 23 (4) ◽

pp. e25916

Author(s):

Deirdre E Logan ◽

Laura E Simons ◽

Thomas J Caruso ◽

Jeffrey I Gold ◽

Walter Greenleaf ◽

...

Keyword(s):

Chronic Pain ◽

Virtual Reality ◽

Pain Management ◽

Augmented Reality ◽

Digital Health ◽

Clinical Care ◽

Pediatric Chronic Pain ◽

Widespread Access ◽

Chronic Pain Conditions ◽

Interdisciplinary Network

Background Virtual reality (VR) and augmented reality (AR) interventions are emerging as promising tools in the treatment of pediatric chronic pain conditions. However, in this young field, there is little consensus to guide the process of engaging in the development and evaluation of targeted VR-based interventions. Objective The INOVATE-Pain (Interdisciplinary Network on Virtual and Augmented Technologies for Pain management) consortium aims to advance the field of VR for pediatric chronic pain rehabilitation by providing guidance for best practices in the design, evaluation, and dissemination of VR-based interventions targeting this population. Methods An interdisciplinary meeting of 16 academics, clinicians, industry partners, and philanthropy partners was held in January 2020. Results Reviewing the state of the field, the consortium identified important directions for research-driven innovation in VR and AR clinical care, highlighted key opportunities and challenges facing the field, and established a consensus on best methodological practices to adopt in future efforts to advance the research and practice of VR and AR in pediatric pain. The consortium also identified important next steps to undertake to continue to advance the work in this promising new area of digital health pain interventions. Conclusions To realize the promise of this realm of innovation, key ingredients for success include productive partnerships among industry, academic, and clinical stakeholders; a uniform set of outcome domains and measures for standardized evaluation; and widespread access to the latest opportunities, tools, and resources. The INOVATE-Pain collaborative hopes to promote the creation, rigorous yet efficient evaluation, and dissemination of innovative VR-based interventions to reduce pain and improve quality of life for children.

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

Uses of Virtual Reality (VR) for Chronic Pain

Advances in Psychology, Mental Health, and Behavioral Studies - Virtual and Augmented Reality in Mental Health Treatment ◽

10.4018/978-1-5225-7168-1.ch013 ◽

2019 ◽

pp. 221-240

Author(s):

Bradley Chi ◽

Brian Chau ◽

Phillip Ta

Keyword(s):

Chronic Pain ◽

Virtual Reality ◽

Therapeutic Option ◽

Underlying Mechanism ◽

Societal Cost ◽

Reality Therapy ◽

Quality Of Evidence ◽

Pediatric Populations ◽

Chronic Pain Conditions

Chronic pain affects many people worldwide with significant individual impact and societal cost. One such area involves the psychiatric co-morbidities associated with chronic pain. Despite its prevalence, the underlying mechanism of chronic pain is not fully understood although evidence suggests the importance of biologic, psychologic, and social factors in the perception of pain. Virtual reality has the potential to be a powerful therapeutic option for chronic pain. This may be due to its impact on attention, emotion, and potentially central nervous system plasticity. Virtual reality therapy has been used successfully for a variety of chronic pain conditions showing its potential. It has also been safely used in pediatric populations. However, the major current limitation is quality of evidence; therefore, future studies should aim to address this issue.

Download Full-text

Craniotomy

Acute Pain Medicine ◽

10.1093/med/9780190856649.003.0016 ◽

2019 ◽

pp. 221-245

Author(s):

Roxana Grasu ◽

Sally Raty

Keyword(s):

Risk Factors ◽

Pain Management ◽

Side Effects ◽

Respiratory Depression ◽

Pain Control ◽

Sensory Nerves ◽

Current Evidence ◽

Multimodal Approach ◽

Perivascular Nerves ◽

Persistent Headache

This chapter discusses postcraniotomy headache (PCH), a common yet frequently underdiagnosed and undertreated occurrence, with up to 30% of patients experiencing persistent headache after surgery. The chapter identifies risk factors for the development of acute and persistent PCH and describes mechanisms for its development, such as injury to the sensory nerves supplying the scalp and underlying tissues or to the perivascular nerves that supply sensation to the dura mater. Pain management following craniotomy is a balancing act of achieving adequate analgesia while avoiding oversedation, respiratory depression, hypercapnia, nausea, vomiting, and hypertension. Current evidence suggests that a balanced, multimodal approach to the treatment of acute PCH is often required to optimize pain control, minimize undesired side effects, and prevent the development of persistent PCH.

Download Full-text

Noncoding RNAs

Anesthesiology ◽

10.1097/aln.0000000000000265 ◽

2014 ◽

Vol 121 (2) ◽

pp. 409-417 ◽

Cited By ~ 56

Author(s):

Brianna Marie Lutz ◽

Alex Bekker ◽

Yuan-Xiang Tao

Keyword(s):

Chronic Pain ◽

Dorsal Root Ganglion ◽

Antisense Rna ◽

Dorsal Root ◽

Molecular Mechanisms ◽

Noncoding Rnas ◽

Current Evidence ◽

Noxious Stimuli ◽

Chronic Pain Conditions ◽

Novel Therapeutic Strategies

Abstract Chronic pain, a common clinical symptom, is often treated inadequately or ineffectively in part due to the incomplete understanding of molecular mechanisms that initiate and maintain this disorder. Newly identified noncoding RNAs govern gene expression. Recent studies have shown that peripheral noxious stimuli drive expressional changes in noncoding RNAs and that these changes are associated with pain hypersensitivity under chronic pain conditions. This review first presents current evidence for the peripheral inflammation/nerve injury–induced change in the expression of two types of noncoding RNAs, microRNAs, and Kcna2 antisense RNA, in pain-related regions, particularly in the dorsal root ganglion. The authors then discuss how peripheral noxious stimuli induce such changes. The authors finally explore potential mechanisms of how expressional changes in dorsal root ganglion microRNAs and Kcna2 antisense RNA contribute to the development and maintenance of chronic pain. An understanding of these mechanisms may propose novel therapeutic strategies for preventing and/or treating chronic pain.

Download Full-text

Pain medicine

10.1093/med/9780199609956.003.0026 ◽

2014 ◽

Author(s):

Jeremy Prout ◽

Tanya Jones ◽

Daniel Martin

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Management Strategies ◽

Multidisciplinary Management ◽

Pain Medicine ◽

Pain Pathways ◽

Patient Groups ◽

Chronic Pain Conditions ◽

Sites Of Action ◽

Specific Management

This chapter summarizes the assessment and management of acute and chronic pain for FRCA. Pain pathways and physiological consequences of pain are considered along with sites of action and the pharmacology of common analgesics. Assessment of pain for different patient groups and settings is explained. Pain management strategies, pharmacological, non-interventional and interventional techniques are described, including multidisciplinary management of chronic pain. Specific management of some common chronic pain conditions, such as trigeminal neuralgia, are discussed in more detail.

Download Full-text

The Role of Cannabidiol (CBD) in Chronic Pain Management: An Assessment of Current Evidence

Current Pain and Headache Reports ◽

10.1007/s11916-020-0835-4 ◽

2020 ◽

Vol 24 (2) ◽

Cited By ~ 8

Author(s):

Shafik Boyaji ◽

Justin Merkow ◽

R. Noel M. Elman ◽

Alan D. Kaye ◽

R. Jason Yong ◽

...

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Current Evidence ◽

Chronic Pain Management

Download Full-text

Neuropathic pain in patients with haemophilia, that is the question

Hämostaseologie ◽

10.1055/s-0037-1619823 ◽

2015 ◽

Vol 35 (S 01) ◽

pp. S5-S9 ◽

Cited By ~ 6

Author(s):

S. Krüger ◽

T. Hilberg

Keyword(s):

Rheumatoid Arthritis ◽

Chronic Pain ◽

Neuropathic Pain ◽

Differential Diagnosis ◽

Pain Management ◽

Pain Mechanisms ◽

Number Of Patients ◽

Paindetect Questionnaire ◽

Chronic Disorders ◽

Chronic Pain Conditions

SummaryChronic pain caused by recurrent joint bleedings affects a large number of patients with haemophilia (PwH). The basis of this pain, nociceptive or neuropathic, has not been investigated so far. In other pain-related chronic disorders such as osteoarthritis or rheumatoid arthritis, initial studies showed nociceptive but also neuropathic pain features. 137 PwH and 33 controls (C) completed the painDETECT-questionnaire (pDq), which identifies neuropathic components in a person´s pain profile. Based on the pDq results, a neuropathic pain component is classified as positive, negative or unclear. A positive neuropathic pain component was found in nine PwH, but not in C. In 20 PwH an unclear pDq result was observed. In comparison to C the allocation of pDq results is statistically significant (p≤0.001). Despite various pDq results in PwH and C a similar appraisal pain quality, but on a different level, was determined. Summarising the results, there is a potential risk to misunderstand underlying pain mechanisms in PwH. In chronic pain conditions based on haemophilic arthopathy, a differential diagnosis seems to be unalterable for comprehensive and individualised pain management in PwH.

Download Full-text

Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids

Children ◽

10.3390/children6020033 ◽

2019 ◽

Vol 6 (2) ◽

pp. 33 ◽

Cited By ~ 10

Author(s):

Anava Wren ◽

Alexandra Ross ◽

Genevieve D’Souza ◽

Christina Almgren ◽

Amanda Feinstein ◽

...

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Psychological Functioning ◽

Pediatric Patients ◽

Multidisciplinary Treatment ◽

Evidence Base ◽

Opioid Therapy ◽

Management Approach ◽

Chronic Pain Conditions ◽

Multidisciplinary Pain Management

Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.

Download Full-text

Understanding transdermal buprenorphine and a practical guide to its use for chronic cancer and non-cancer pain management

Journal of Opioid Management ◽

10.5055/jom.2019.0496 ◽

2019 ◽

Vol 15 (2) ◽

pp. 147-158 ◽

Cited By ~ 2

Author(s):

Tony O’Brien, MB, FRCPI ◽

Jin Seok Ahn, MD ◽

Richard Chye, MBBS, FRACP, FFPMANZCA, FAChPM ◽

Brian Le, MBBS (Hons), MPH, FRACP, FAChPM ◽

Henry Lu, MD, DABPN, DPBPM ◽

...

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Pain Management ◽

Cancer Pain ◽

Chronic Pain Management ◽

Cancer Pain Management ◽

Appropriate Use ◽

Chronic Pain Conditions ◽

Favorable Safety ◽

Practical Recommendations

Transdermal buprenorphine (TDB) has demonstrated effectiveness in treating a range of chronic pain conditions, including cancer pain, nociceptive pain, and neuropathic pain and has a favorable safety profile. Worldwide, clinical experience of its use is relatively limited. There is considerable misunderstanding about the pharmacology, mechanism of action, and safety of buprenorphine. There is also limited guidance on the appropriate use of TDB for chronic pain management. This article presents an overview of TDB and also provides practical recommendations for its use as part of a multifaceted strategy in chronic cancer and non-cancer pain.

Download Full-text