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Pain is an incredibly common problem affecting more individuals than diabetes, heart disease, and cancer combined, and it can cost Americans anywhere from $560 to $635 billion in terms of direct medical care and lost productivity (Kenney & Milling, 2016).  Previous studies have indicated that psychological interventions like distraction, cognitive-behavior therapy, biofeedback, acceptance based approaches, and hypnosis can all be very effective in reducing pain (Kenney & Milling, 2016).  Distraction works by drawing an individual’s focus away from a painful stimulus and towards some other action or event (Kenney & Milling, 2016).  Distraction is based on the premise that individuals have a limited attentional capacity, and that by pulling focus away from the pain and toward a different stimulus a person then has a decreased ability to focus on their pain (Kenney & Milling, 2016).  Virtual reality (VR) creates a multi-sensory, three-dimensional (3D) environment utilizing a head mounted display, headphones, and a joystick or wand (Kenney & Milling, 2016).  The head mounted display tracks head motion to allow users to look around the world and the joystick or wand allows users to move and interact in the simulated environment (Kenney & Milling, 2016).  To date VR distraction has shown great promise in managing experimental pain, the discomfort associated with wound care for burn victims, and needle-related pain, with the best results noted when more sophisticated technology was used to fully immerse the individual (Kenney & Milling, 2016).

Meta-analysis findings indicate that VR distraction is a highly effective intervention for dealing with pain with patients who received VR benefitted 82% more than control subjects (Kenney & Milling, 2016).  Additionally impressive was that VR distraction showed benefits for patients independent of types of pain, age groups, or the type of software used (Kenney & Milling, 2016).  Findings also appear to indicate that VR simulations that create a sense of being in the virtual world and foster enjoyment for the user may be most useful in providing effective distraction; therefore, use of commercial VR games may be just as effective or more effective than software specially designed for VR distraction (Kenney & Milling, 2016).

To provide a more real-world example of how this technology is being utilized in Hua, Qui, Yao, Zhang, & Chen (2014) utilized VR distraction to analyze pain relief during dressing changes for children with chronic wounds to their lower limbs.  Children were allowed to play a VR videogame, Ice Age 2: The Meltdown, during dressing changes to provide distraction from a normally painful procedure (Hua, et al., 2014).  The VR device was introduced to the children by nursing staff, and once the child was well acquainted with the device the nurse proceeded to perform the child’s normal dressing change (Hua, et al., 2014).  Children who utilized the VR distraction reported a significant decrease in reported pain and observed distress (Hua, et al., 2014).  VR distraction was also shown to lead to a lower heart rate during dressing changes and decreased the amount of time needed to perform the dressing change (Hua, et al., 2014).  This study serves to illustrate one way nurses can easily implement this technology into their practice to positively impact patient care.

VR distraction has shown to be one of the most effective psychological interventions for reducing pain, and is a treatment modality that physicians should consider especially if other psychological interventions have not been successful (Kenney & Milling, 2016).  With this technology becoming increasingly affordable and more widely available we may see a day where it is standard of care for certain patient populations.  I look forward to seeing how we utilize this technology moving forward, and given its promise I hope to see greater adoption from clinicians in the coming years.

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Soldiers Get Virtual Reality Therapy for Burn Pain

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Produced by Joyce Gramza Edited by James Eagan It's pain you wouldn't wish on your worst enemy, lets alone our veterans. But now soldiers enduring treatment for severe burns are being offered a high-tech way of fighting the pain.

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Understanding the science of pain, with the help of virtual reality

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Inside the search for new drugs and techniques to replace habit-forming opioids, science correspondent Miles O'Brien discovers future pain treatments may rely on virtual reality.

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Highly effective intervention for pain (Kenney & Milling, 2016)

Required technology is becoming more affordable and widely available (Kenney & Milling, 2016)

May have applications for chronic pain patients during acute exacerbations (Kenney & Milling, 2016)

Useful for all ages and for all types of pain (Kenney & Milling, 2016)

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VR-induced nausea may cause some users to need frequent breaks (Stein, 2016)

May lead to eye strain or fatigue (Stein, 2016)

Unable to see or hear things in the real world around you due to engrossing VR world (Stein, 2016)

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Given the overwhelmingly positive results noted in the meta-analysis of VR distraction studies I think this technology is something we should look to embrace.  The potential for aiding those who require extensive, painful dressing changes, alleviating needle related pain, and those who suffer from other types of clinical pain has been well established.  More work appears to need to be done on chronic pain, but given VR distractions utility in other pain related applications it is conceivable to assume that VR distraction could be a highly effective tool in this population as well. VR distraction also comes with very few negatives for its users.  As long as sessions are not prolonged nausea and eye strain are avoidable, and patients using VR distraction are unlikely to be running into or hitting objects in the real world while using the device since they will be in a highly controlled environment with medical professionals present.  That being said, I see no reason for clinicians not to adopt this technology in the coming years as cost will continue to decline and availability with continue to improve.

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Hua, Y., Qiu, R., Yao, W., Zhang, Q., & Chen, X. (2015). The Effect of Virtual Reality Distraction on Pain Relief During Dressing Changes in Children with Chronic Wounds on Lower Limbs. Pain Management Nursing, 16(5), 685-691.

Kenney, M., & Milling, L. (2016). The Effectiveness of Virtual Reality Distraction for Reducing Pain: A Meta-Analysis. Psychology of Consciousness: Theory, Research, and Practice, Psychology of Consciousness: Theory, Research, and Practice, 2016.

Stein, S. (2016). The dangers of virtual reality. Retrieved October 6, 2017, from https://www.cnet.com/news/the-dangers-of-virtual-reality/