Welcome to this second in our series of articles exploring virtual reality healthcare and its many potential uses. After VR Physiotherapy we now move to the treatment of acute pain through, in essence, distraction.
'Distraction' is the key word for me… it is the ability of VR to take a patient away from the real world, away from focusing on the painful treatment that they are receiving and put them into another place which is both believable and draws their attention.
We can't at the moment get away from the fact that opioid analgesics remain the corner stone of virtually every regime to control pain but if we go right back to the early 90's, David Patterson published research upon how psychological treatment could be considered an adjunct to pharmacology.He then linked up with Hunter Hoffman who, in 2000, published his research: Virtual Reality as an Adjunctive Pain Control During Burn Wound Care in Adolescent Patients [Hoffman et al. Pain 85 (2000) 305 – 309].
VR is a uniquely attention capturing medium capable of drawing attention drawn away from the 'real world' thereby allowing patients to tolerate painful procedures.
In addition to their normal opioid pain relief the patients in Hoffman's initial study spent time both playing a video game and in VR with the idea being that VR would have a more immersive effect than conventional distraction techniques.
Hoffman initially thought that the technique would work best for young people and adolescents but in 2007 Sharar published his research: Factors Influencing the Efficacy of Virtual Reality Distraction Analgesia During Post Burn Physical Therapy [Sharar et al: Arch Phys Med Rehabil Vol 88, Suppl 2, December 2007]
He concluded that VR distraction is an effective, adjunctive pharmacologic analgesic technique for burn-related rehabilitation activities. Compared with standard analgesic care alone, this intervention resulted in significant reductions in complementary subjective patient pain ratings which did not appear to be affected by age, sex or ethnicity: a mean reduction of 20% across the entire comparison group for worst pain intensity, 26% for pain unpleasantness, and 37% for time spent thinking about pain.
And so was born SnowWorld [warning, opens video link]: developed at the University of Washington in collaboration with Harborview Burn Center this was the first immersive virtual world designed for reducing pain. SnowWorld was specifically designed to help burn patients.
The essence of VR is the illusion users have of going inside the computer-generated environment. Being drawn into another world leaves less attention available to process pain signals.
There are a number of alternatives now available. To give one such example, Mobius Floe is an immersive virtual reality game designed as a tool to help acute pain patients lower their pain and anxiety. The game includes many tasks that stimulate the patients’ working memory and seek their constant attention, thus drawing the patients’ focus away from their physical pain.
I listened to a talk by Samsung's Chief Medical Officer, David Rhew at ACRM #94 in Atlanta last year. As one would expect from the focus which Samsung have put in to their VR Gear they are heavily involved in research in this area. Samsung have partnered with Travelers Insurance, Bayer, AppliedVR and Mount Sinai Hospital to fund a 16 month study of between 90 and 140 patients. The link with Travelers will extend into looking at how VR therapy impacts a worker's compensation environment: specifically cost and return to work.
At ACRM David announced some initial results based on patient testimonials… 24% reduction in pain; 60% reduction in anxiety with pain relief potentially lasting for 24 – 48 hrs.
Interesting that in the States Samsung are already linking up with an insurer. Admittedly it’s a very different environment to the one that we operate under in the UK but if nothing else it shows the direction of travel…