Advertisement

Virtual Reality Distraction to Help Control Acute Pain during Medical Procedures

  • Hunter G. Hoffman
  • Walter J. MeyerIII
  • Sydney A. Drever
  • Maryam Soltani
  • Barbara Atzori
  • Rocio Herrero
  • Wadee Alhalabi
  • Todd L. Richards
  • Sam R. Sharar
  • Mark P. Jensen
  • David R. Patterson
Chapter
Part of the Virtual Reality Technologies for Health and Clinical Applications book series (VRTHCA)

Abstract

Excessive pain during medical procedures is a widespread problem. Severe pain is especially problematic for severe burn patients who often endure dozens of wound cleanings/debridements and dozens of physical therapy sessions over a period of weeks or months after their initial injury. Pain medications help substantially, but are typically inadequate to control such intense pain from mechanical stimulation of pain receptors during severe burn wound cleaning/debridement. Immersive Virtual Reality (VR) distraction, a nonpharmacologic analgesic used in addition to traditional pain medications, may help bring pain down to more tolerable levels during medical procedures. Patients report 35–50% reductions in procedural pain while in a distracting immersive world, and fMRI brain scans show large drops in pain-related brain activity during virtual reality analgesia (www.vrpain.com). Contrary to concerns that distraction would not work with patients in severe to excruciating pain, preliminary results show that VR distraction is most effective for patients who need it the most, those with the highest pain intensity levels. VR is thought to reduce pain by blocking people’s view of the real world, directing patients’ attention into the virtual world, leaving less attention available to process incoming signals from pain receptors. Consistent with an attentional mechanism, results of laboratory studies show that highly immersive VR systems (hypothesized to be more attention demanding) reduce pain more effectively than less immersive VR systems. We review evidence from clinical and laboratory research studies exploring Virtual Reality analgesia, concentrating primarily on the work ongoing within our group. We briefly describe preliminary results of VR applications for settings other than burn patients; dental fears patients, venipuncture, cerebral palsy patients during physical therapy, older male patients undergoing endoscopic trans-urethral microwave thermo-therapy of an enlarged benign prostate, and patients in pain from a blunt force trauma injury. Finally, we briefly discuss recent and future improvements in VR distraction technology.

Keywords

Virtual reality Pain distraction Analgesia Non-pharmacologic pain reduction 

Notes

Acknowledgments

This manuscript was funded by the following NIH grants2R01GM042725-21A1 (PI Patterson), NIH 1R01AR054115-01A1 (PI Sharar), Shriners Hospitals for Children, Tampa Florida (award ID #71011-GAL2018, PI Walter Meyer III, MD), and from a charitable donation from the MayDay Fund (PI Walter Meyer III, MD).

The current Springer chapter is an updated version of the following Springer journal review manuscript. Significant portions of the following article originally published by Springer are reproduced verbatim in the current chapter, with kind permission from Springer Science+Business Media and with authors’ permission. Hoffman HG, Chambers GT, Meyer WJ 3rd, Arceneaux LL, Russell WJ, Seibel EJ, Richards TL, Sharar SR, Patterson DR. Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Ann Behav Med. 2011;41:183–91. Copyrighted by The Society of Behavioral Medicine 2011.

Conflict of Interest Statement

The authors have no conflict of interest to disclose.

References

  1. American Burn Association: Burn Incidence and Treatment in the US. (2007) Fact sheet. From http://www.ameriburn.org/resources_factsheet.php.
  2. Atzori, B., Lauro Grotto, R., Giugni, A., Calabrò, M., Alhalabi, W., & Hoffman, H. G. (2018a). Virtual reality analgesia for pediatric dental patients. Frontiers in Psychology, 9, 2265.CrossRefGoogle Scholar
  3. Atzori, B., Hoffman, H. G., Vagnoli, L., Patterson, D. R., Alhalabi, W., Messeri, A., et al. (2018b). Virtual reality analgesia during venipuncture in pediatric patients with Onco-hematological diseases. Frontiers in Psychology, 9, 2508.Google Scholar
  4. Berger, A. C., & Whistler, J. L. (2010). How to design an opioid drug that causes reduced tolerance and dependence. Annals of Neurology, 67, 559–569.CrossRefGoogle Scholar
  5. Carrougher, G. J., Hoffman, H. G., Nakamura, D., et al. (2009). The effect of virtual reality on pain and range of motion in adults with burn injuries. Journal of Burn Care & Research, 30, 785–791.CrossRefGoogle Scholar
  6. Cherny, N., Ripamonti, C., Pereira, J., et al. (2001). Strategies to manage the adverse effects of oral morphine: An evidence-based report. Journal of Clinical Oncology, 19, 2542–2554.CrossRefGoogle Scholar
  7. Crombez, G., Eccleston, C., Baeyens, F., & Eelen, P. (1998). When somatic information threatens, catastrophic thinking enhances attentional interference. Pain, 75, 187–198.CrossRefGoogle Scholar
  8. Dahlquist, L. M., McKenna, K. D., Jones, K. K., et al. (2007). Active and passive distraction using a head-mounted display helmet: Effects on cold pressor pain in children. Health Psychology, 26, 794–801.CrossRefGoogle Scholar
  9. Das, D., Grimmer, K., Sparnon, A., McRae, S., & Thomas, B. (2005). The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: A randomized controlled trial. BMC Pediatric, 5, 1.CrossRefGoogle Scholar
  10. Eccleston, C. (2001). Role of psychology in pain management. British Journal of Anaesthesia, 87, 144–152.CrossRefGoogle Scholar
  11. Eccleston, C., & Crombez, G. (1999). Pain demands attention: A cognitive-affective model of the interruptive function of pain. Psychological Bulletin, 125, 356–366.CrossRefGoogle Scholar
  12. Fernandez, E., & Turk, D. C. (1989). The utility of cognitive coping strategies for altering pain perception: A meta-analysis. Pain, 38, 123–135.CrossRefGoogle Scholar
  13. Flores, A., Hoffman, H.G., Russell, W., et al. (2008). Longer, multiple virtual reality pain distraction treatments of Hispanic and Caucasian children with large severe burns. CyberTherapy Conference. San Diego.Google Scholar
  14. Furman, E., Jasinevicius, T. R., Bissada, N. F., et al. (2009). Virtual reality distraction for pain control during periodontal scaling and root planing procedures. Journal of the American Dental Association, 140, 1508–1516.CrossRefGoogle Scholar
  15. Garcia-Palacios, A., Hoffman, H. G., Richards, T. R., et al. (2007). Use of virtual reality distraction to reduce claustrophobia symptoms during a mock magnetic resonance imaging brain scan: A case report. Cyberpsychology & Behavior, 10, 485–488.CrossRefGoogle Scholar
  16. Garrett, B., Taverner, T., Masinde, W., Gromala, D., Shaw, C., & Negraeff, M. (2014). A rapid evidence assessment of immersive virtual reality as an adjunct therapy in acute pain management in clinical practice. The Clinical Journal of Pain, 30, 1089–1098.CrossRefGoogle Scholar
  17. Gershon, J., Zimand, E., Pickering, M., et al. (2004). A pilot and feasibility study of virtual reality as a distraction for children with cancer. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1243–1249.CrossRefGoogle Scholar
  18. Gold, J. I., & Mahrer, N. E. (2018). Is virtual reality ready for prime time in the medical space? A randomized control trial of pediatric virtual reality for acute procedural pain management. Journal of Pediatric Psychology, 43(3), 266–275.CrossRefGoogle Scholar
  19. Gold, J. I., Kim, S. H., Kant, A. J., Joseph, M. H., & Rizzo, A. S. (2006). Effectiveness of virtual reality for pediatric pain distraction during i.v. placement. Cyberpsychology & Behavior, 9, 207–212.CrossRefGoogle Scholar
  20. Gracely, R. H., McGrath, P., & Dubner, R. (1978). Ratio scales of sensory and affective verbal pain descriptors. Pain, 5, 5–18.CrossRefGoogle Scholar
  21. Hoffman, H. G. (1998). Virtual reality: A new tool for interdisciplinary psychology research. Cyberpsychology & Behavior, 1, 195–200.CrossRefGoogle Scholar
  22. Hoffman, H. G. (2004). Virtual reality therapy. Scientific American, 291, 58–65.CrossRefGoogle Scholar
  23. Hoffman, H. G., Doctor, J. N., Patterson, D. R., Carrougher, G. J., & Furness, T. A. (2000a). 3rd: Use of virtual reality as an adjunctive treatment of adolescent burn pain during wound care: A case report. Pain, 85, 305–309.CrossRefGoogle Scholar
  24. Hoffman, H. G., Patterson, D. R., & Carrougher, G. J. (2000b). Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: A controlled study. The Clinical Journal of Pain, 16, 244–250.CrossRefGoogle Scholar
  25. Hoffman, H. G., Garcia-Palacios, A., Patterson, D. R., Jensen, M. P., & Furness, T. A., III. (2001). The effectiveness of virtual reality for dental pain control: A case study. Cyberpsychology & Behavior, 4, 527–535.CrossRefGoogle Scholar
  26. Hoffman, H. G., Garcia-Palacios, A., Kapa, V. A., et al. (2003a). Immersive virtual reality for reducing experimental ischemic pain. International Journal of Human-Computer Interaction., 15, 469–486.CrossRefGoogle Scholar
  27. Hoffman, H. G., Richards, T. L., Magula, J., et al. (2003b). A magnet-friendly virtual reality fiberoptic image delivery system. Cyberpsychology & Behavior, 6, 645–648.CrossRefGoogle Scholar
  28. Hoffman, H. G., Patterson, D. R., Magula, J., et al. (2004a). Water-friendly virtual reality pain control during wound care. Journal of Clinical Psychology, 60, 189–195.CrossRefGoogle Scholar
  29. Hoffman, H. G., Sharar, S. R., Coda, B., et al. (2004b). Manipulating presence influences the magnitude of virtual reality analgesia. Pain, 111, 162–168.CrossRefGoogle Scholar
  30. Hoffman, H. G., Richards, T. L., Coda, B., et al. (2004c). Modulation of thermal pain-related brain activity with virtual reality: Evidence from fMRI. Neuroreport, 15, 1245–1248.CrossRefGoogle Scholar
  31. Hoffman, H. G., Seibel, E. J., Richards, T. L., et al. (2006a). Virtual reality helmet display quality influences the magnitude of virtual reality analgesia. The Journal of Pain, 7, 843–850.CrossRefGoogle Scholar
  32. Hoffman, H. G., Richards, T. L., Bills, A. R., et al. (2006b). Using fMRI to study the neural correlates of virtual reality analgesia. CNS Spectrums, 11, 45–51.CrossRefGoogle Scholar
  33. Hoffman, H. G., Richards, T. L., Van Oostrom, T., et al. (2007). The analgesic effects of opioids and immersive virtual reality distraction: Evidence from subjective and functional brain imaging assessments. Anesthesia and Analgesia, 105, 1776–1783. table of contents.CrossRefGoogle Scholar
  34. Hoffman, H. G., Patterson, D. R., Seibel, E., et al. (2008a). Virtual reality pain control during burn wound debridement in the hydrotank. The Clinical Journal of Pain, 24, 299–304.CrossRefGoogle Scholar
  35. Hoffman, H. G., Patterson, D. R., Soltani, M., et al. (2008b). Virtual reality pain control during physical therapy range of motion exercises for a patient with multiple blunt force trauma injuries. Cyberpsychology & Behavior, 19, 47–49.Google Scholar
  36. Hoffman, H. G., Chambers, G. T., Meyer, W. J., 3rd, Arceneaux, L. L., Russell, W. J., Seibel, E. J., Richards, T. L., Sharar, S. R., & Patterson, D. R. (2011). Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Annals of Behavioral Medicine, 41, 183–9169.CrossRefGoogle Scholar
  37. Hoffman, H. G., Meyer, W. J., 3rd, Ramirez, M., et al. (2014). Feasibility of articulated arm mounted oculus rift virtual reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients. Cyberpsychology, Behavior and Social Networking, 17, 397–401.CrossRefGoogle Scholar
  38. Jensen, M. P. (2003). The validity and reliability of pain measures in adults with cancer. Journal of Pain, 4, 2–21.CrossRefGoogle Scholar
  39. Kahneman, D. (1973). Attention and effort. Englewood Cliffs: Prentice-Hall.Google Scholar
  40. Keefe, F. J., Huling, D. A., Coggins, M. J., Keefe, D. F., Zachary Rosenthal, M., Herr, N. R., & Hoffman, H. G. (2012). Virtual reality for persistent pain: A new direction for behavioral pain management. Pain, 153, 2163–2166.CrossRefGoogle Scholar
  41. Keefe, F. J., Main, C. J., & George, S. Z. (2018). Advancing psychologically informed practice for patients with persistent musculoskeletal pain: Promise, pitfalls, and solutions. Physical Therapy, 98, 398–407.  https://doi.org/10.1093/ptj/pzy024.CrossRefPubMedGoogle Scholar
  42. Khadra, C., Ballard, A., Déry, J., Paquin, D., Fortin, J. S., Perreault, I., Labbe, D. R., Hoffman, H. G., Bouchard, S., & LeMay, S. (2018). Projector-based virtual reality dome environment for procedural pain and anxiety in young children with burn injuries: A pilot study. Journal of Pain Research, 11, 343–353.CrossRefGoogle Scholar
  43. Kipping, B., Rodger, S., Miller, K., & Kimble, R. M. (2012). Virtual reality for acute pain reduction in adolescents undergoing burn wound care: A prospective randomized controlled trial. Burns, 38(5), 650–657.CrossRefGoogle Scholar
  44. Klassen, J. A., Liang, Y., Tjosvold, L., et al. (2008). Music for pain and anxiety in children undergoing medical procedures: A systematic review of randomized controlled trials. Ambulatory Pediatrics, 8, 117–128.CrossRefGoogle Scholar
  45. Liebovici, V., Magora, F., Cohen, S., & Ingber, A. (2009). Effects of virtual reality immersion and audiovisual distraction techniques for patients with pruritus. Pain Research & Management, 14, 283–286.CrossRefGoogle Scholar
  46. Maani, C., Hoffman, H. G., DeSocio, P. A., et al. (2008). Pain control during wound care for combat-related burn injuries using custom articulated arm mounted virtual reality goggles. Journal of CyberTherapy and Rehabilitation, 1, 193–198.Google Scholar
  47. Maani, C. V., Hoffman, H. G., Morrow, M., et al. (2011a). Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles. The Journal of Trauma, 71(1 Suppl), S125–S130.CrossRefGoogle Scholar
  48. Maani, C. V., Hoffman, H. G., Fowler, M., et al. (2011b). Combining ketamine and virtual reality pain control during severe burn wound care: One military and one civilian patient. Pain Medicine, 12, 673–678.CrossRefGoogle Scholar
  49. Malloy, K. M., & Milling, L. S. (2010). The effectiveness of virtual reality distraction for pain reduction: A systematic review. Clinical Psychology Review, 30, 1011–1018.CrossRefGoogle Scholar
  50. Martin, M. J., Holcomb, J., Polk, T., Hannon, M., Eastridge, B., Malik, S. Z., ... et al. (2019). The “top 10” Research and development priorities for battlefield surgical care: Results from the committee on surgical combat casualty care research gap analysis. Journal of Trauma and Acute Care Surgery. https://doi.org/10.1097/TA.0000000000002200.CrossRefGoogle Scholar
  51. McCaul, K. D., & Malott, J. M. (1984). Distraction and coping with pain. Psychological Bulletin, 95, 516–533.CrossRefGoogle Scholar
  52. McSherry, T., Atterbury, M., Gartner, S., et al. (2018). Randomized, crossover study of immersive virtual reality to decrease opioid use during painful wound care procedures in adults. Journal of Burn Care & Research, 39, 278–285.Google Scholar
  53. Melzack, R. (1990). The tragedy of needless pain. Scientific American, 262, 27–33.CrossRefGoogle Scholar
  54. Montgomery, G. H., DuHamel, K. N., & Redd, W. H. (2000). A meta-analysis of hypnotically induced analgesia: How effective is hypnosis? The International Journal of Clinical and Experimental Hypnosis, 48, 138–153.CrossRefGoogle Scholar
  55. Morris, L. D., Louw, Q. A., & Grimmer-Somers, K. (2009). The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: A systematic review. The Clinical Journal of Pain, 25, 815–826.CrossRefGoogle Scholar
  56. Patterson, D. R. (2001). Is hypnotic pain control effortless or effortful? Hypnos, 28, 132–134.Google Scholar
  57. Patterson, D. R. (2010). Clinical hypnosis for pain control. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  58. Patterson, D. R., & Jensen, M. P. (2003). Hypnosis and clinical pain. Psychological Bulletin, 129, 495–521.CrossRefGoogle Scholar
  59. Patterson, D. R., Hoffman, H. G., Palacios, A. G., & Jensen, M. P. (2006). Analgesic effects of posthypnotic suggestions and virtual reality distraction on thermal pain. Journal of Abnormal Psychology, 115, 834–841.CrossRefGoogle Scholar
  60. Perry, S., Heidrich, G., & Ramos, E. (1981). Assessment of pain by burn patients. Journal of Burn Care and Rehabilitation, 2, 322–326.CrossRefGoogle Scholar
  61. Ptacek, J., Patterson, D., & Doctor, J. (2000). Describing and predicting the nature of procedural pain after thermal injuries: Implications for research. Journal of Burn Care and Rehabilitation, 21, 318–326.CrossRefGoogle Scholar
  62. Schmitt, Y. S., Hoffman, H. G., Blough, D. K., et al. (2011). A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns. Burns, 37, 61–68.CrossRefGoogle Scholar
  63. Schneider, S. M., Prince-Paul, M., Allen, M. J., et al. (2004). Virtual reality as a distraction intervention for women receiving chemotherapy. Oncology Nursing Forum, 31, 81–88.CrossRefGoogle Scholar
  64. Shang, A. B., & Gan, T. J. (2003). Optimising postoperative pain management in the ambulatory patient. Drugs, 63, 855–867.CrossRefGoogle Scholar
  65. Sharar, S. R., Carrougher, G. J., Nakamura, D., et al. (2007). Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: Preliminary results from 3 ongoing studies. Archives of Physical Medicine and Rehabilitation, 88, S43–S49.CrossRefGoogle Scholar
  66. Slater, M., & Wilbur, S. (1997). A framework for immersive virtual environments (FIVE): Speculations on the role of presence in virtual environments. Presence Teleoperators and Virtual Environments, 6, 603–616.CrossRefGoogle Scholar
  67. Soltani, M., Drever, S. A., Hoffman, H. G., Sharar, S. R., Wiechman, S. A., Jensen, M. P., & Patterson, D. R. (2018). Virtual reality analgesia for burn joint flexibility: A randomized controlled trial. Rehabilitation Psychology, 63, 487–494.CrossRefGoogle Scholar
  68. Steele, E., Grimmer, K., Thomas, B., et al. (2003). Virtual reality as a pediatric pain modulation technique: A case study. Cyberpsychology & Behavior, 6, 633–638.CrossRefGoogle Scholar
  69. van der Heijden, M. J. E., Jeekel, J., Rode, H., et al. (2018). Can live music therapy reduce distress and pain in children with burns after wound care procedures? A randomized controlled trial. Burns, 44, 823–833.CrossRefGoogle Scholar
  70. van Twillert, B., Bremer, M., & Faber, A. W. (2007). Computer-generated virtual reality to control pain and anxiety in pediatric and adult burn patients during wound dressing changes. Journal of Burn Care & Research, 28, 694–702.CrossRefGoogle Scholar
  71. Ward, R. (1998). Physical rehabilitation. In G. Carrougher (Ed.), Burn care and therapy (pp. 293–327). New York: Mosby.Google Scholar
  72. Wender, R., Hoffman, H. G., Hunner, H. H., et al. (2009). Interactivity influences the magnitude of virtual reality analgesia. Journal of Cyber Therapy and Rehabilitation, 2, 27–33.PubMedPubMedCentralGoogle Scholar
  73. Windich-Biermeier, A., Sjoberg, I., Dale, J. C., et al. (2007). Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer. Journal of Pediatric Oncology Nursing, 24, 8–19.CrossRefGoogle Scholar
  74. Wright, J. L., Hoffman, H. G., & Sweet, R. M. (2005). Virtual reality as an adjunctive pain control during transurethral microwave thermotherapy. Urology, 66, 1320.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Hunter G. Hoffman
    • 1
  • Walter J. MeyerIII
    • 2
  • Sydney A. Drever
    • 3
  • Maryam Soltani
    • 3
  • Barbara Atzori
    • 4
  • Rocio Herrero
    • 5
    • 6
  • Wadee Alhalabi
    • 7
    • 8
  • Todd L. Richards
    • 9
  • Sam R. Sharar
    • 10
  • Mark P. Jensen
    • 3
  • David R. Patterson
    • 3
  1. 1.Human Photonics Lab, Department of Mechanical EngineeringUniversity of WashingtonSeattleUSA
  2. 2.University of Texas Medical Branch and Shriners Children’s HospitalGalvestonUSA
  3. 3.Department of Rehabilitation MedicineUniversity of WashingtonSeattleUSA
  4. 4.Department of Health SciencesUniversity of FlorenceFlorenceItaly
  5. 5.University JaumeCastellónSpain
  6. 6.University of WashingtonSeattleUSA
  7. 7.Department of Computer ScienceKing Abdulaziz UniversityJeddahSaudi Arabia
  8. 8.Department of Computer ScienceEffat UniversityJeddahSaudi Arabia
  9. 9.Department of RadiologyUniversity of WashingtonSeattleUSA
  10. 10.Department of AnesthesiologyUniversity of Washington Harborview Medical CenterSeattleUSA

Personalised recommendations