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      Virtual Reality as an Adjunct Home Therapy in Chronic Pain Management: An Exploratory Study

      research-article
      , RN, PhD 1 , , , RN, PhD 1 , , BSc 2
      (Reviewer), (Reviewer)
      JMIR Medical Informatics
      JMIR Publications
      pain management, chronic illness, therapeutics, medical informatics

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          Abstract

          Background

          Virtual reality (VR) therapy has been successfully used as an adjunct therapy for the management of acute pain in adults and children, and evidence of potential efficacy in other health applications is growing. However, minimal research exists on the value of VR as an intervention for chronic pain.

          Objective

          This case series examined the value of VR to be used as an adjunctive therapy for chronic pain patients in their own homes.

          Methods

          An exploratory approach using a case series and personal interviews was used. Ten chronic pain patients received VR therapy for 30 min on alternate days for 1 month. Pre- and postexposure (immediately afterwards, 3 h, and at 24 h) pain assessment was recorded using the Numerical Rating Scale (NRS), and weekly using the Brief Pain Inventory (BPI) and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS). Terminal semistructured personal interviews with the patients were also undertaken.

          Results

          Of the 8 patients who completed the study, 5 of them reported that pain was reduced during the VR experience but no overall treatment difference in pain scores postexposure was observed. VR was not associated with any serious adverse events, although 60% of patients reported some cybersickness during some of the experiences.

          Conclusions

          Of note is that the majority of these study participants reported a reduction in pain while using the VR but with highly individualized responses. One patient also reported some short-term improved mobility following VR use. Some evidence was found for the short-term efficacy of VR in chronic pain but no evidence for persistent benefits.

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          Most cited references52

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          Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge.

          Despite nursing's enthusiastic endorsement of the applicability of qualitative research approaches to answering relevant clinical questions, many nurse researchers have been hesitant to depart from traditional qualitative research methods. While various derivations of phenomenology, grounded theory, and ethnography have been popularized within qualitative nursing research, the methodological principles upon which these approaches are based reflect the foundations and objectives of disciplines whose aims are sometimes quite distinct from nursing's domain of inquiry. Thus, as many nurse researchers have discovered, nursing's unique knowledge mandate may not always be well served by strict adherence to traditional methods as the "gold standard" for qualitative nursing research. The authors present the point of view that a non-categorical description, drawing on principles grounded in nursing's epistemological mandate, may be an appropriate methodological alternative for credible research toward the development of nursing science. They propose a coherent set of strategies for conceptual orientation, sampling, data construction, analysis, and reporting by which nurses can use an interpretive descriptive approach to develop knowledge about human health and illness experience phenomena without sacrificing the theoretical or methodological integrity that the traditional qualitative approaches provide.
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            Why patients use alternative medicine: results of a national study.

            J A Astin (1998)
            Research both in the United States and abroad suggests that significant numbers of people are involved with various forms of alternative medicine. However, the reasons for such use are, at present, poorly understood. To investigate possible predictors of alternative health care use. Three primary hypotheses were tested. People seek out these alternatives because (1) they are dissatisfied in some way with conventional treatment; (2) they see alternative treatments as offering more personal autonomy and control over health care decisions; and (3) the alternatives are seen as more compatible with the patients' values, worldview, or beliefs regarding the nature and meaning of health and illness. Additional predictor variables explored included demographics and health status. A written survey examining use of alternative health care, health status, values, and attitudes toward conventional medicine. Multiple logistic regression analyses were used in an effort to identify predictors of alternative health care use. A total of 1035 individuals randomly selected from a panel who had agreed to participate in mail surveys and who live throughout the United States. Use of alternative medicine within the previous year. The response rate was 69%. The following variables emerged as predictors of alternative health care use: more education (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.3); poorer health status (OR, 1.3; 95% CI, 1.1-1.5); a holistic orientation to health (OR, 1.4; 95% CI, 1.1-1.9); having had a transformational experience that changed the person's worldview (OR, 1 .8; 95% CI, 1 .3-2.5); any of the following health problems: anxiety (OR, 3.1; 95% CI, 1.6-6.0); back problems (OR, 2.3; 95% CI, 1 .7-3.2); chronic pain (OR, 2.0; 95% CI, 1.1 -3.5); urinarytract problems (OR, 2.2; 95% CI, 1.3-3.5); and classification in a cultural group identifiable by their commitment to environmentalism, commitment to feminism, and interest in spirituality and personal growth psychology (OR, 2.0; 95% CI, 1.4-2.7). Dissatisfaction with conventional medicine did not predict use of alternative medicine. Only 4.4% of those surveyed reported relying primarily on alternative therapies. Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.
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              A discussion of cybersickness in virtual environments

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                Author and article information

                Contributors
                Journal
                JMIR Med Inform
                JMIR Med Inform
                JMI
                JMIR Medical Informatics
                JMIR Publications (Toronto, Canada )
                2291-9694
                Apr-Jun 2017
                11 May 2017
                : 5
                : 2
                : e11
                Affiliations
                [1] 1School of Nursing University of British Columbia Vancouver, BCCanada
                [2] 2Faculty of Science University of British Columbia Vancouver, BCCanada
                Author notes
                Corresponding Author: Bernie Garrett bernie.garrett@ 123456nursing.ubc.ca
                Author information
                http://orcid.org/0000-0003-0411-6767
                http://orcid.org/0000-0002-3462-903X
                http://orcid.org/0000-0003-3531-4803
                Article
                v5i2e11
                10.2196/medinform.7271
                5445235
                28495661
                9833ddf3-7884-49b4-9a3f-a232e5716a59
                ©Bernie Garrett, Tarnia Taverner, Paul McDade. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 11.05.2017.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on http://medinform.jmir.org/, as well as this copyright and license information must be included.

                History
                : 5 January 2017
                : 23 February 2017
                : 1 March 2017
                : 18 March 2017
                Categories
                Original Paper
                Original Paper

                pain management,chronic illness,therapeutics,medical informatics

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