Is Virtual Reality an Oasis for Pain?

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Is Virtual Reality an Oasis for Pain?

• Karen Keene
• Jessica Lam
• Emma Lever

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Introduction

• Presence
• Applications of Virtual reality
• -Combating phobias
• -Post-traumatic stress disorder (PTSD)
• -SpiderWorld (Hoffman)

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SpiderWorld
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Effectiveness of Virtual Reality Based Pain
Control

• Pain perception
• Use of VR to treat pain is based research that
  has found that distraction is a cognitive
  behavioral intervention particularly useful with
  burn pain
• VR differs from other forms of distraction in
  that it draws more of the patients attention
  into the virtual environment (i.e., greater
  degree of distraction)

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Virtual reality programmes used during wound care
in burn victims
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Why is VR effective?

• Attention
• Pain thought of as a gate that can be open or
  closed Melzack Wall (1965)
• Depends on ascending signals from peripheral
  nervesdescending signals from CNS

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Water-friendly VR

• Used for wound care in hydro-tanks
• Hydro tanks sterile baths for loosening
  bandages cleaning wounds

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VR use in Hydro-tank

• No electricity involved to reduce risk of
  electric shock
• 2 independent computerized images, one for each
  eye

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Case study

• 40 year old man
• Deep flame burns to 19 of total body area
• Study 3 minutes in VR, 3 minutes with no
  distraction
• Randomly assigned to VR condition first
• Finger controlled joy stick to move around
  virtual world

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Snow World

• 3D icy canyon
• Snowy and cold to counteract fiery pain
• Illusion of flying fighter jet
• Shoot snowballs with joy stick

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Case study cont

• Pain and presence ratings on 10 point graphic
  scale
• Rated worst pain, amount of time spent thinking
  about pain etc
• After wound care rated side effects and
  presence

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Outcomes
Sensory pain Affective pain Time thinking
No VR 7 6 10
VR 2 3 3

• VR condition more fun
• Sense of presence 6
• Realism of virtual objects 7
• No simulation sickness
• Therefore evidence of effectiveness

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Methodological Issues

• Only one patient included
• Demand characteristics, treatment order effects,
  novelty and expectancies not controlled for
• VR only used for 3 minutes in reality,
  treatments can last up to 45 minutes

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Controversies

• Not enough studies to draw firm conclusions
• Novelty value
• Generally subjective measures, although fMRI
  supports findings
• Limited age range of participants
• Expensive issues of access

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Controversies

• Difficult to retain necessary programming to keep
  up to date
• Lead to exclusion of traditional individual
  coping techniques
• Reducing use of opioid painkillers
• Different susceptibilities to feeling of presence

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Controversies

• Ocular-motor disturbances/ simulation sickness
• Long term consequences?
• Detrimental effects on social skills?
• Confusion between reality and fantasy
• Disorientation
• VR distraction must end at some point

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Controversies

• Risk of developing dependence
• Enhancement of pain when outside VR?
• Lack of suitability for chronic pain
• How to decide who should be allowed access

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Conclusion

• Ethical issues and controversies deserve
  consideration
• More research needed
• VR in pain management promising

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References

• Hoffman H.G., Doctor J.N., Patterson, D.R.,
  Carrougher, G.J. and Furness, T.A. III (2000).
  Use of virtual reality for adjunctive treatment
  of adolescent burn pain during wound care A case
  report. Pain, 85, 305-309.
• Hoffman H.G, Patterson D.R. and Carrougher, G.J.
  (2000). Use of virtual reality for adjunctive
  treatment of adult burn pain during physical
  therapy a controlled study. Clinical Journal of
  Pain, 16(3), 244-250.
• Hoffman, H.G., Patterson, D.R., Carrougher, G.J.
  and Sharar, S. (2001). The effectiveness of
  virtual reality based pain control with multiple
  treatments. Clinical Journal of Pain, 17,
  229-235.
• Hoffman, H. G., Patterson, D. R., Magula, J.,
  Carrougher, G. J., Zeltzer, K., Dagadakis, S.,
  Sharar, S. R. (2004). Water-friendly virtual
  reality pain control during wound care. JCLP/In
  Session, 60(2), 189-195
• Melzack R. Wall P. D. (1965) Pain mechanisms a
  new theory. Science 150 971-979.
• Rauterberg, M. (2004). Positive effects of VR
  technology on human behaviour. ICAT, 85-88