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      Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis

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          Abstract

          Background: Previous studies have shown that virtual reality (VR) is effective in reducing acute and chronic pain both in adults and in children. Given the emergence of new VR technology, and the growing body of research surrounding VR and pain management, an updated systematic review is warranted.

          Purpose: The purpose of this systematic review is to compare the effectiveness of VR in reducing acute and chronic pain in adults.

          Data Sources: A search was conducted in three databases (PubMed, CINAHL, Trip) using standardized search terms.

          Study Selection: Twenty experimental and quasi-experimental trials published between January 2007 and December 2018 were included based on prespecified inclusion and exclusion criteria. Pain intensity was the primary outcome.

          Data Extraction: We extracted data and appraised the quality of articles using either the PEDro or Modified Downs and Black risk of bias tools.

          Data Synthesis: The majority of studies supported the use of VR to reduce acute pain both during the procedure and immediately after. Numerous studies found VR reduced chronic pain during VR exposure but there is insufficient evidence to support lasting analgesia. There was considerable variability in patient population, pain condition and dosage of VR exposure.

          Limitations: Due to heterogeneity, we were unable to perform meta-analyses for all study populations and pain conditions.

          Conclusions: VR is an effective treatment for reducing acute pain. There is some research that suggests VR can reduce chronic pain during the intervention; however, more evidence is needed to conclude that VR is effective for lasting reductions in chronic pain.

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          Most cited references 42

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          The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study.

           Anick De Vos (2008)
          Does the PEDro scale measure only one construct ie, the methodological quality of clinical trials? What is the hierarchy of items of the PEDro scale from least to most adhered to? Is there any effect of year of publication of trials on item adherence? Are PEDro scale ordinal scores equivalent to interval data? Rasch analysis of two independent samples of 100 clinical trials from the PEDro database scored using the PEDro scale. Both samples of PEDro data showed fit to the Rasch model with no item misfit. The PEDro scale item hierarchy was the same in both samples, ranging from the most adhered to item random allocation, to the least adhered to item therapist blinding. There was no differential item functioning by year of publication. Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores (r = 0.99). The PEDro scale is a valid measure of the methodological quality of clinical trials. It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis.
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            The effectiveness of virtual reality distraction for pain reduction: a systematic review.

            Virtual reality technology enables people to become immersed in a computer-simulated, three-dimensional environment. This article provides a comprehensive review of controlled research on the effectiveness of virtual reality (VR) distraction for reducing pain. To be included in the review, studies were required to use a between-subjects or mixed model design in which VR distraction was compared with a control condition or an alternative intervention in relieving pain. An exhaustive search identified 11 studies satisfying these criteria. VR distraction was shown to be effective for reducing experimental pain, as well as the discomfort associated with burn injury care. Studies of needle-related pain provided less consistent findings. Use of more sophisticated virtual reality technology capable of fully immersing the individual in a virtual environment was associated with greater relief. Overall, controlled research suggests that VR distraction may be a useful tool for clinicians who work with a variety of pain problems. Copyright © 2010 Elsevier Ltd. All rights reserved.
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              Virtual reality as an adjunctive pain control during burn wound care in adolescent patients.

              For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the first evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care. The first was a 16-year-old male with a deep flash burn on his right leg requiring surgery and staple placement. On two occasions, the patient spent some of his wound care in VR, and some playing a video game. On a 100 mm scale, he provided sensory and affective pain ratings, anxiety and subjective estimates of time spent thinking about his pain during the procedure. For the first session of wound care, these scores decreased 80 mm, 80 mm, 58 mm, and 93 mm, respectively, during VR treatment compared with the video game control condition. For the second session involving staple removal, scores also decreased. The second patient was a 17-year-old male with 33.5% total body surface area deep flash burns on his face, neck, back, arms, hands and legs. He had difficulty tolerating wound care pain with traditional opioids alone and showed dramatic drops in pain ratings during VR compared to the video game (e.g. a 47 mm drop in pain intensity during wound care). We contend that VR is a uniquely attention-capturing medium capable of maximizing the amount of attention drawn away from the 'real world', allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                03 July 2019
                2019
                : 12
                : 2053-2085
                Affiliations
                [1 ]Department of Physical Therapy, St. Mary’s Medical Center , San Francisco, CA, USA
                [2 ]Castro Valley Yoga , Castro Valley, CA, USA
                [3 ]Department of Physical Therapy, Kaiser Permanente , Oakland, CA, USA
                [4 ]Department of Physical Therapy, Samuel Merritt University , Oakland, CA, USA
                Author notes
                Correspondence: Benjamin S BoydDepartment of Physical Therapy, Samuel Merritt University , 450 30th Street, Suite 3728, Oakland, CA94609, USATel +1 510 879 9200 x7376Fax +1 510 457 2112Email bboyd1@ 123456samuelmerritt.edu
                Article
                200498
                10.2147/JPR.S200498
                6613199
                © 2019 Mallari et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 2, Tables: 1, References: 54, Pages: 33
                Categories
                Review

                Anesthesiology & Pain management

                adult, analgesia, acute, chronic, pain management, virtual reality

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