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Is Virtual Reality an Oasis for Pain?

Is Virtual Reality an Oasis for Pain?. Karen Keene Jessica Lam Emma Lever. Introduction. Presence Applications of Virtual reality -Combating phobias -Post-traumatic stress disorder (PTSD) -SpiderWorld (Hoffman). SpiderWorld. Effectiveness of Virtual Reality – Based Pain Control.

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Is Virtual Reality an Oasis for Pain?

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  1. Is Virtual Reality an Oasis for Pain? Karen Keene Jessica Lam Emma Lever

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

  3. SpiderWorld

  4. 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 patient’s attention into the virtual environment (i.e., greater degree of distraction)

  5. Virtual reality programmes used during wound care in burn victims

  6. 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 nerves+descending signals from CNS+

  7. Water-friendly VR • Used for wound care in hydro-tanks • Hydro tanks = sterile baths for loosening bandages & cleaning wounds

  8. VR use in Hydro-tank • No electricity involved to reduce risk of electric shock • 2 independent computerized images, one for each eye

  9. 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

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

  11. 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’

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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. Conclusion • Ethical issues and controversies deserve consideration • More research needed • VR in pain management = promising

  19. 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

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