28 February 2006


I've written here before about the use of virtual reality in treating pain during medical procedures. Here's a collection of abstracts that I've come across recently:

Use of Virtual Reality as a Distractor for Painful Procedures in a Patient with Pediatric Cancer: A Case Study
Jonathan Gershon, Elana Zimand, Rosemarie Lemos, Barbara Olasov Rothbaum, Larry Hodges
Virtual reality (VR) has been demonstrated as an effective tool to help people overcome a variety of anxiety disorders. In this case study, the use of VR as a distractor to alleviate pain and anxiety associated with an invasive medical procedure for a pediatric cancer patient was explored. An A-B-C-A design during four consecutive medical appointments in an outpatient oncology clinic compared no distraction (A), non-VR distraction on a computer screen (B), and VR distraction with a head set (C). Behavioral observations of distress by the researcher and reports of pain and anxiety by the patient, parent, and nurse were taken before and during the procedure. The child's pulse was monitored throughout the procedure. The findings from this case study suggest benefit from using VR distraction, as indicated by lower pain and anxiety ratings, reduced pulse, and fewer observed behavioral indices of distress. The need for larger scale studies and application of VR with younger children is discussed in the context of confirming effectiveness of this technique and providing more generalizable information about efficacy. CyberPsychology & Behavior. Dec 2003, Vol. 6, No. 6: 657-661

Effects of Distraction Using Virtual Reality Glasses During Lumbar Punctures in Adolescents With Cancer
Suzanne Sander Wint, RN, BSN, CPON, Debra Eshelman, RN, MSN, CPNP, Jill Steele, RN, MSN, and Cathie E. Guzzetta, RN, PhD, HNC, FAAN

Purpose/Objectives: To determine the effects of virtual reality (VR) glasses on adolescents with cancer undergoing lumbar punctures (LPs).

Design: Pilot study using an experimental, control group design.

Setting: In-hospital oncology clinic.

Sample: 30 adolescents with cancer (17 in the VR and 13 in the control group) undergoing frequent LPs.

Methods: Subjects were randomly assigned to groups. Both groups received standard intervention during the LP, but the experimental group also wore VR glasses and watched a video. Following the LP, both groups rated their pain using a visual analog scale (VAS) and were interviewed to evaluate their experience.

Main Research Variables: Pain, subjective evaluation of experience.

Findings: Although VAS pain scores were not statistically different between the two groups (p = 0.77), VAS scores tended to be lower in the VR group (median VAS of 7.0, range 0-48) than in the control group (median VAS of 9.0, range 0-59). 77% of subjects in the experimental group said the VR glasses helped to distract them from the LP.

Conclusions: VR glasses are a feasible, age-appropriate, nonpharmacologic adjunct to conventional care in managing the pain associated with LPs in adolescents.

Implications for Practice: The clinical application of various age-appropriate distracters to reduce pain in adolescents undergoing painful procedures should be explored.

Immersive Virtual Reality for Reducing Experimental Ischemic Pain
Hunter G. Hoffman, Azucena Garcia-Palacios, Veronica Kapa, Jennifer Beecher, Sam R. Sharar
This study explored the novel use of immersive virtual environments as a nonpharmacologic pain control technique and whether it works for both men and women. Fourteen female and 8 male students underwent pain induced via a blood pressure cuff ischemia lasting 10 min or less. Pain ratings increased significantly every 2 min during the no distraction phase (0 to 8 min) and dropped dramatically during the last 2 min period when participants were in the virtual environment (a 59% drop for women and a 41% drop for men). Five visual analog pain scores for each treatment condition served as the primary dependent variables. All 22 participants reported a drop in pain in the virtual environment, and the magnitude of pain reduction from the virtual environment was large (a 52% drop) and statistically significant. This is the first study to show immersive virtual environment distraction is also effective for women. The results show that virtual environments can function as a strong nonpharmacologic pain reduction technique, showing the same pattern of results obtained from recent clinical studies using virtual environments with burn patients during physical therapy. Practical applications of virtual environment pain reduction, and the value of a multidisciplinary approach to studying pain are discussed. International Journal of Human-Computer Interaction, 2003, Vol. 15, No. 3, Pages 469-486 (doi: 10.1207/S15327590IJHC1503_10)

Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer Suzanne Sander and Jill Steele
Key points:
*Virtual reality glasses are a feasible, age-appropriate, nonpharmacologic adjunct to converntional care in managing pain associated with lumbar punctures in adolescents with cancer.
*visual analogue pain scores tended to be lower in the VR group
*The majority of adolescents who received the VR glasses felt the glasses distracted them from the lumbar puncture and wanted to use them again.
*More research is needed to explore novel distraction techniques for managing pediatric pain associated with procedures
Link (full text)

Virtual Reality Pain Distraction
Hunter Hoffman, PhD, and David Patterson, PhD ABPP ABPH
Patients commonly report experiencing excessive pain during medical procedures (Melzack, 1990), especially during severe burn wound care (Carrougher et al., 2003). Although opioid analgesics are currently essential for pain control during burn wound care, dosage amounts are limited by side effects (e.g., nausea, constipation, interference with appetite, sleep cycles) and other concerns associated with this class of medications (Cherny et al., 2001). Pain control is particularly challenging for patients with severe burn injuries. Patients treated for this form of trauma typically undergo daily wound care to clean, prevent infection, monitor the healing progress, and bandage again. Most burn patients report severe to excruciating pain during these medical procedures (Carrougher et al., 2003). APS Bulletin SPRING 2005 • VOLUME 15, NUMBER 2
Link (full text)

The effectiveness of virtual reality based pain control with multiple treatments.
Hoffman, H.G., Patterson, D.R., Carrougher, G.J., & Sharar, S. (2001).
Objective: The present study explored whether immersive virtual reality continues to reduce pain (via distraction) with repeated use.

Setting: Burn care unit at a regional trauma center.

Patients: Seven patients aged 9-32 years, mean age = 21.9 years (average of 23.7% total body surface area burned, range TBSA = 3% to 60%), performed range of motion exercises of their injured extremity under an occupational therapist’s direction on at least three separate days each.

Intervention: For each physical therapy session, each patient spent equal amounts of time in VR and in the control condition (no distraction). The mean duration of physical therapy in VR was 3.5, 4.9 and 6.4 minutes for the first, second and third session, respectively. Condition order was randomized and counterbalanced.

Outcome measures: For each of the three physical therapy sessions, five visual analog pain scores for each treatment condition served as the dependent variables.

Results: Pain ratings were statistically lower when patients were in VR, and the magnitude of VR pain reduction did not diminish with repeated use of VR. The results of this study may be examined in more detail at www.vrpain.com.

Conclusions: Although the small sample size limits generalizability, results provide converging preliminary evidence that virtual reality can function as a strong nonpharmacologic pain reduction technique for burn patients during physical therapy. Results suggest that virtual reality does not diminish in analgesic effectiveness with three (and possibly more) uses. Virtual reality may also have analgesic potential for other painful procedures or pain populations. Practical implications are discussed. Clinical Journal of Pain, 17, 229-235.
Link (full text)

And a link with even more resources: www.vrpain.com

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