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What is distraction therapy and how can it be used to treat pain?

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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).

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How is virtual reality therapy being used in real life?
Source details:
https://youtu.be/hK4WJ6mNDDM

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Researchers at CHLA are studying the use of virtual reality to reduce pain in children and adolescents undergoing painful medical procedures. Jeffrey Gold, PhD, a clinical psychologist and director of the Pediatric Pain Management Clinic, explains his research.

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Benefits of VR distraction therapy on graft patients

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Benefits of VR distraction therapy on graft patients

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Source details: https://depts.washington.edu/hplab/research/virtual-reality/
This graph depicts the results of a study completed at a regional burn center in Washington state. Patient one suffered from severe burns over most of his body while patient two suffered from burns on his right upper arm (Human Photonics Laboratory, 2019). The patient's in this study were treated with medications and then treated with virtual reality therapy to determine if virtual reality had any effect on pain and anxiety during treatments such as grafts or wound care (Human Photonics Laboratory, 2019). "When patients are resting (most of the time), opioids (morphine and morphine-related chemicals) are adequate for controlling their burn pain.  In sharp contrast, during wound care such as daily bandage changes, wound cleaning, staple removals etc., opioids are not enough, not even close" (Human Photonics Laboratory, 2019). The patient's were then introduced to virtual reality therapy and educated on playing a Nintendo game during therapy (Human Photonics Laboratory, 2019.  The logic behind why virtual works is as follows "pain perception has a strong psychological component. The same incoming pain signal can be interpreted as painful or not, depending on what the patient is thinking. Pain requires conscious attention. The essence of VR is the illusion users have of going inside the computer-generated environment. Being drawn into another world drains a lot of attentional resources, leaving less attention available to process pain signals. Conscious attention is like a spotlight. Usually it is focused on the pain and wound care" (Human Photonics Laboratory, 2019). Encouragingly,  as seen in the graph below both patient's report less pain and anxiety with virtual reality therapy (Human Photonics Laboratory, 2019).

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What are the pros of virtual reality therapy?

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Pros

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)

Decreased pain and anxiety during treatments such as wound care and daily bandage changes for burn patients (Human Photonics Laboratory, 2019)

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Are there any cons to virtual reality therapy?

Cons

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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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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My five strengths include:
1. Harmony
2. Deliberative
3. Intellection
4. Input
5. Consistency
My evaluation team:
1. David
-Rational: I chose David because of his deliberative nature or thoughtful care he would take in making decisions (Gallup, 2018). David will be an important part of our decision making team.
2. Ivan
- Rational: I chose Ivan because he is seen to be exceptionally talented as an intellectual person (Gallup, 2018). Ivan will be an essential person to have conversations with as I also have intellection as one of my talents.
3.  Carlee
-Rational: Carlee will be an asset to my team because she is shown to excel in the consistency theme which means she "is keenly aware of the need to treat people the same" (Gallup, 2018).
4.  Izzie
-Rational: Izzie will become a part of my team to create this innovation because she is shown to excel in the input theme which means they "accumulate information, ideas, artifacts, or even relationships" (Gallup, 2018). She will be important because of the thoughtful nature she will take with the information we will collect.
5. Isabelle
Rational-  Although I do not have includer as one of my top my strengths, I believe Isabelle will be important to our team because she will ensure everyone's voice is heard and that no one is left out (Gallup, 2018).

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Children's Hospital of Los Angeles. (2017). Can virtual reality help manage pain? Retrieved from: https://www.youtube.com/watch?v=hK4WJ6mNDDM

Gallup. (2018).  Includer. Retrieved from: https://news.gallup.com/businessjournal/682/includer.aspx

Gallup. (2018). Strengths insight report. Retrieved from: https://gx.gallup.com/services/pdf?v=pdfGeneration.prince.7.0.binPath

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.

Human Photonics Laboratory. (2019). Virtual reality pain reduction. Retrieved from: http://www.vrpain.com

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/