Virtual Reality Distraction to Help Control Acute Pain during Medical Procedures
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.
KeywordsVirtual reality Pain distraction Analgesia Non-pharmacologic pain reduction
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.
- American Burn Association: Burn Incidence and Treatment in the US. (2007) Fact sheet. From http://www.ameriburn.org/resources_factsheet.php.
- 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
- 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
- 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
- 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
- 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
- Kahneman, D. (1973). Attention and effort. Englewood Cliffs: Prentice-Hall.Google Scholar
- 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
- 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
- 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
- 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
- Patterson, D. R. (2001). Is hypnotic pain control effortless or effortful? Hypnos, 28, 132–134.Google Scholar
- Ward, R. (1998). Physical rehabilitation. In G. Carrougher (Ed.), Burn care and therapy (pp. 293–327). New York: Mosby.Google Scholar