USING VIRTUAL REALITY FOR PAIN MANAGEMENT IN CHILDREN

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.

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The Effectiveness of Virtual Reality in Managing Acute Pain and Anxiety for Medical Inpatients: Systematic Review

Journal of Medical Internet Research ◽

10.2196/17980 ◽

2020 ◽

Vol 22 (11) ◽

pp. e17980

Author(s):

Vinayak Smith ◽

Ritesh Rikain Warty ◽

Joel Arun Sursas ◽

Olivia Payne ◽

Amrish Nair ◽

...

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Side Effects ◽

Acute Pain ◽

Clinical Setting ◽

Reality Therapy ◽

Autonomic Arousal ◽

Inpatient Setting ◽

Virtual Reality Therapy ◽

Head Mounted Display

Background Virtual reality is increasingly being utilized by clinicians to facilitate analgesia and anxiolysis within an inpatient setting. There is however, a lack of a clinically relevant review to guide its use for this purpose. Objective To systematically review the current evidence for the efficacy of virtual reality as an analgesic in the management of acute pain and anxiolysis in an inpatient setting. Methods A comprehensive search was conducted up to and including January 2019 on PubMed, Ovid Medline, EMBASE, and Cochrane Database of Systematic reviews according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms included virtual reality, vr, and pain. Primary articles with a focus on acute pain in the clinical setting were considered for the review. Primary outcome measures included degree of analgesia afforded by virtual reality therapy, degree of anxiolysis afforded by virtual reality therapy, effect of virtual reality on physiological parameters, side effects precipitated by virtual reality, virtual reality content type, and type of equipment utilized. Results Eighteen studies were deemed eligible for inclusion in this systematic review; 67% (12/18) of studies demonstrated significant reductions in pain with the utilization of virtual reality; 44% (8/18) of studies assessed the effects of virtual reality on procedural anxiety, with 50% (4/8) of these demonstrating significant reductions; 28% (5/18) of studies screened for side effects with incidence rates of 0.5% to 8%; 39% (7/18) of studies evaluated the effects of virtual reality on autonomic arousal as a biomarker of pain, with 29% (2/7) demonstrating significant changes; 100% (18/18) of studies utilized a head mounted display to deliver virtual reality therapy, with 50% being in active form (participants interacting with the environment) and 50% being in passive form (participants observing the content only). Conclusions Available evidence suggests that virtual reality therapy can be applied to facilitate analgesia for acute pain in a variety of inpatient settings. Its effects, however, are likely to vary by patient population and indication. This highlights the need for individualized pilot testing of virtual reality therapy’s effects for each specific clinical use case rather than generalizing its use for the broad indication of facilitating analgesia. In addition, virtual reality therapy has the added potential of concurrently providing procedural anxiolysis, thereby improving patient experience and cooperation, while being associated with a low incidence of side effects (nausea, vomiting, eye strain, and dizziness). Furthermore, findings indicated a head mounted display should be utilized to deliver virtual reality therapy in a clinical setting with a slight preference for active over passive virtual reality for analgesia. There, however, appears to be insufficient evidence to substantiate the effect of virtual reality on autonomic arousal, and this should be considered at best to be for investigational uses, at present.

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Clinicians' quick reference guide to acute pain management in infants, children, and adolescents: Operative and medical procedures

Journal of Pain and Symptom Management ◽

10.1016/0885-3924(92)90079-w ◽

1992 ◽

Vol 7 (4) ◽

pp. 229-242 ◽

Cited By ~ 11

Author(s):

Pain Management Guideline Panel

Keyword(s):

Pain Management ◽

Children And Adolescents ◽

Acute Pain ◽

Medical Procedures ◽

Acute Pain Management ◽

Reference Guide

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Acute pain management in radiation oncology: Quality of care and the impact of an integrated palliative oncology service.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.195 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 195-195 ◽

Cited By ~ 1

Author(s):

Michael A Garcia ◽

Tracy A. Balboni ◽

Steve E. Braunstein ◽

Shannon E. Fogh ◽

Wendy Anderson ◽

...

Keyword(s):

Pain Management ◽

Bone Metastases ◽

Acute Pain ◽

Radiation Oncology ◽

Acute Pain Management ◽

Nccn Guidelines ◽

Analgesic Regimen ◽

Pain Intervention ◽

June July ◽

The Impact

195 Background: Radiotherapy (RT) effectively palliates bone metastases, but relief may take weeks, frequently necessitating acute pain management (APM). NCCN Guidelines for Adult Cancer Pain (V2.2015) recommend initiation/titration of analgesics for patients with pain scale value (PSV) ≥ 4. We sought to evaluate how often symptomatic patients have analgesic regimens assessed and intervened upon at radiation oncology (RO) consult for bone metastases, and the impact of a dedicated palliative RO service on APM. Methods: We reviewed consult notes for 217 bone metastases patients treated with RT at Dana Farber Cancer Institute/Brigham & Women’s Hospital (DFCI/BWH) and University of California, San Francisco (UCSF) during June-July 2008, Jan-Feb 2010, Jan-Feb 2013, and June-July 2014, time periods before and after implementation in 2011 of a dedicated palliative RO service at DFCI/BWH. For symptomatic patients, rate of assessment of analgesic regimen was recorded. Among patients with PSV ≥ 4, rate of pain intervention was recorded. The impact of a palliative RO service on these rates was evaluated. Results: Median age was 63 and median KPS was 70. Median PSV for painful bone metastases was 5 (IQR 2-7); 51% had PSV ≥ 4. Among symptomatic patients, analgesic regimen was assessed for 44.5% (51.7% at DFCI/BWH and 28.1% at UCSF). Among patients with PSV ≥ 4, pain intervention occurred for 17.2% (20.5% for DFCI/BWH, 0% for UCSF). At DFCI/BWH, consultation by a dedicated palliative RO provider was associated with higher rate of assessment of analgesic regimen (82.4% vs 47.7%, p = 0.007). At DFCI/BWH, consultation by a palliative RO provider was associated with higher rate of pain intervention (31.2% vs 7.9%, p = 0.012). There was no difference in analgesic regimen assessment or intervention between non-dedicated palliative RO providers at DFCI/BWH and UCSF (p = 0.07 and 0.09, respectively). Conclusions: At two cancer centers, half of bone metastases patients seen for RT have PSV ≥ 4, yet a minority have analgesic assessment and intervention, indicating need for APM quality improvement in RO. An integrated palliative RO service was associated with improved assessment and management of acute pain per NCCN guidelines.

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The Impact of Technology on the Analgesic Gap and Quality of Acute Pain Management

Regional Anesthesia and Pain Medicine ◽

10.1016/j.rapm.2004.10.009 ◽

2005 ◽

Vol 30 (3) ◽

pp. 286-291 ◽

Cited By ~ 8

Author(s):

D CARR ◽

H REINES ◽

J SCHAFFER ◽

R POLOMANO ◽

S LANDE

Keyword(s):

Pain Management ◽

Acute Pain ◽

Acute Pain Management ◽

Impact Of Technology ◽

The Impact

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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.

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Learning optimal opioid prescribing and monitoring: a simulation study of medical residents

JAMIA Open ◽

10.1093/jamiaopen/ooy026 ◽

2018 ◽

Vol 1 (2) ◽

pp. 246-254 ◽

Cited By ~ 1

Author(s):

Thomas G Kannampallil ◽

Robert McNutt ◽

Suzanne Falck ◽

William L Galanter ◽

Dave Patterson ◽

...

Keyword(s):

Pain Management ◽

Pain Score ◽

Acute Pain ◽

Management Practices ◽

Longitudinal Design ◽

Simulator Training ◽

Appropriate Use ◽

Long Acting ◽

Prospective Longitudinal ◽

The Impact

Abstract Objective Hospitalized patients often receive opioids. There is a lack of consensus regarding evidence-based guidelines or training programs for effective management of pain in the hospital. We investigated the viability of using an Internet-based opioid dosing simulator to teach residents appropriate use of opioids to treat and manage acute pain. Materials and methods We used a prospective, longitudinal design to evaluate the effects of simulator training. In face-to-face didactic sessions, we taught 120 (108 internal medicine and 12 family medicine) residents principles of pain management and how to use the simulator. Each trainee completed 10 training and, subsequently, 5 testing trials on the simulator. For each trial, we collected medications, doses, routes and times of administration, pain scores, and a summary score. We used mixed-effects regression models to assess the impact of simulation training on simulation performance scores, variability in pain score trajectories, appropriate use of short- and long-acting opioids, and use of naloxone. Results Trainees completed 1582 simulation trials (M = 13.2, SD = 6.8), with sustained improvements in their simulated pain management practices. Over time, trainees improved their overall simulated pain management scores (b = 0.05, P < .01), generated lower pain score trajectories with less variability (b = −0.02, P < .01), switched more rapidly from short-acting to long-acting agents (b = −0.50, P < .01), and used naloxone less often (b = −0.10, P < .01). Discussion and conclusions Trainees translated their understanding of didactically presented principles of pain management to their performance on simulated patient cases. Simulation-based training presents an opportunity for improving opioid-based inpatient acute pain management.

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Virtual Reality as Analgesia

International Journal of Creative Interfaces and Computer Graphics ◽

10.4018/ijcicg.2014070105 ◽

2014 ◽

Vol 5 (2) ◽

pp. 75-86 ◽

Cited By ~ 1

Author(s):

Mark Nazemi ◽

Diane Gromala ◽

Mehdi Karamnejad

Keyword(s):

Chronic Pain ◽

Virtual Reality ◽

Pain Management ◽

Interface Design ◽

Pain Reduction ◽

Self Management ◽

Sound Design ◽

Interactive Approach ◽

Pharmacological Method

This paper introduces a multidisciplinary and interactive approach to self-management of chronic pain using Virtual Reality (VR). This approach is meant to reduce the reliance on heavy use of medication and provide a non-pharmacological method for pain management. In addition, the paper discusses additional technologies that deal with issues surrounding immersion, presence, and interface design that directly impact the quality of treatment patients can obtain through VR therapy. A set of guidelines are also included that signify the importance of using biofeedback and interactive sound design to help improve rehabilitation and meditation practices for pain reduction.

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Guided relaxation-based virtual reality versus distraction-based virtual reality or passive control for postoperative pain management in children and adolescents undergoing Nuss repair of pectus excavatum: protocol for a prospective, randomised, controlled trial (FOREVR Peds trial)

BMJ Open ◽

10.1136/bmjopen-2020-040295 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040295

Author(s):

Vanessa A Olbrecht ◽

Sara E Williams ◽

Keith T O’Conor ◽

Chloe O Boehmer ◽

Gilbert W Marchant ◽

...

Keyword(s):

Virtual Reality ◽

Pain Management ◽

Pain Intensity ◽

Pectus Excavatum ◽

Passive Control ◽

Controlled Trial ◽

Novel Therapy ◽

The Impact ◽

Guided Relaxation ◽

Pain Unpleasantness

IntroductionVirtual reality (VR) offers an innovative method to deliver non-pharmacological pain management. Distraction-based VR (VR-D) using immersive games to redirect attention has shown short-term pain reductions in various settings. To create lasting pain reduction, VR-based strategies must go beyond distraction. Guided relaxation-based VR (VR-GR) integrates pain-relieving mind–body based guided relaxation with VR, a novel therapy delivery mechanism. The primary aim of this study is to assess the impact of daily VR-GR, VR-D and 360 video (passive control) on pain intensity. We will also assess the impact of these interventions on pain unpleasantness, anxiety and opioid and benzodiazepine consumption. The secondary aim of this study will assess the impact of psychological factors (anxiety sensitivity and pain catastrophising) on pain following VR.Methods and analysisThis is a single centre, prospective, randomised, clinical trial. Ninety children/adolescents, aged 8–18 years, presenting for Nuss repair of pectus excavatum will be randomised to 1 of 3 study arms (VR-GR, VR-D and 360 video). Patients will use the Starlight Xperience (Google Daydream) VR suite for 10 min. Patients randomised to VR-GR (n=30) will engage in guided relaxation/mindfulness with the Aurora application. Patients randomised to VR-D (n=30) will play 1 of 3 distraction-based games, and those randomised to the 360 video (n=30) will watch the Aurora application without audio instructions or sound. Primary outcome is pain intensity. Secondary outcomes include pain unpleasantness, anxiety and opioid and benzodiazepine consumption.Ethics and disseminationThis study follows Standard Protocol Items: Recommendations for Interventional Trials guidelines. The protocol was approved by the Cincinnati Children’s Hospital Medical Center’s institutional review board. Patient recruitment began in July 2020. Written informed consent will be obtained for all participants. All information acquired will be disseminated via scientific meetings and published in peer-reviewed journals.Trial registration numberNCT04351776.

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