Pain management in virtual reality: a comprehensive research chart.

ESRA19-0696 Non-pharmacological methods for comfort and pain management (virtual reality, musicotherapy, hypnosis,……)

Background and Objectives: Botulinum toxin injections are commonly used for the treatment of spasticity. However, injection procedures are associated with pain and procedural anxiety. While pharmacological approaches are commonly used to reduce these, innovative technology might be considered as a potential non-pharmacological alternative. Given this context, immersive virtual reality (VR) has shown effectiveness in the management of procedural pain. Our retrospective pilot study aimed to assess the potential added value of virtual reality in the management of pain and anxiety during intramuscular injections of botulinum toxin. Materials and Methods: Seventeen adult patients receiving botulinum toxin injections were included. A numerical rating scale was used to assess pain and anxiety during the injection procedure. The patients reported the pain experienced during previous injections without VR before injection and the pain experienced in the current procedure with VR after the end of the procedure. The level of satisfaction of VR experience, whether or not they agreed to reuse VR for the subsequent toxin botulinum injection, and whether or not they would recommend VR to other patients were assessed. Results: The use of virtual reality led to a decrease of 1.8 pain-related points compared to the procedure without technology. No significant improvement in the level of anxiety was reported. Patients were very satisfied with their VR experiences (7.9 out of 10), and many would agree to reuse VR in their next injection procedure (88%) and to recommend the use of VR in other patients (100%). Conclusion: VR was useful for managing procedural pain related to botulinum toxin injection in adults, with a high level of satisfaction reported by the patients. VR should be considered as a valuable alternative to pharmacological approaches to manage procedural pain during botulinum toxin injection in adults.

Efficacy of Virtual Reality in Managing Pain for Patients in Palliative Care: A Systematic Review and Meta-Analysis

Background- Virtual reality (VR) is an effective drug-free tool for management of pain. However, its use remains elusive in developing countries like Nigeria.Objectives: To characterize studies conducted on using virtual reality in managing pain. Methods: A comprehensive systematic review was conducted for studies done globally from 2000 to 2016. Databases (Google, Pubmed, BioMed Central, Mendeley) were searched to identify eligible studies. Search terms included: Virtual reality, Virtual patients, and management of pain using VR. Data extracted included: Title/authors of articles, objectives, study design, methods, population, age group, primary disease conditions, VR equipment, environments, display technology/ senses needed, country of study, effect of VR plus pharmacologic analgesia, and study outcomes. Results: Out of 3821 potentially relevant articles identified 24(0.63%) were eligible. Fourteen (58.3%) and 8(33.3%) studies were Randomized Control Trials, and Case Studies/Reports respectively. A total of 8(33.3%) and 3(12.5%) studies were on Burn pain and Phantom limb pain respectively. Seventeen (70.8%) studies had adults as target population. Thirteen (54.2%) studies were done in the USA, 19 (79.2%) were Immersive VR, 15(62.5%) had head mounted display as display technology, and 22 (91.67%) had positive outcomes. VR plus pharmacologic analgesia 8 (33.37%) had positive outcomes. No study was found for Nigeria. Conclusion: This review demonstrates wide range of characteristics for studies encountered and VR is shown as effective for reducing pain in different disease conditions even when combined with pharmacological analgesia. The absence of studies on management of pain using VR in Nigeria calls for creation of awareness among major stakeholders.

To examine the efficacy of an immersive virtual reality distraction compared with an active non-immersive distraction, such as video games on a tablet, for pain and anxiety management and memory of pain and anxiety in children requiring percutaneous bone pins and/or suture removal procedures. Three-centre randomized clinical trial using a parallel design with two groups: experimental and control. Study to take place in the orthopaedic department of three children hospital of the Montreal region starting in 2019. Children, from 7-17years old, requiring bone pins and/or suture removal procedures will be recruited. The intervention group (N=94) will receive a virtual reality game (Dreamland), whereas the control group (N=94) will receive a tablet with video games. The primary outcomes will be both the mean self-reported pain score measured by the Numerical Rating Scale and mean anxiety score, measured by the Child Fear Scale. Recalls of pain and anxiety will be measured 1week after the procedure using the same scales. We aim to recruit 188 children to achieve a power of 80% with a significance level (alpha) of 5%. While multiple pharmacological methods have previously been tested for children, no studies have evaluated the impact of immersive virtual reality distraction for pain and anxiety management in the orthopaedic setting. Improved pain management can be achieved using virtual reality during medical procedures for children. This method is innovative, non-pharmacological, adapted to the hospital setting, and user-friendly. NCT03680625, registered on clinicaltrials.gov.

Background/Objectives: Virtual reality (VR), a component of extended reality (XR), has shown promise in pre-procedural planning by providing immersive, patient-specific simulations. In pain management, where precise anatomical understanding is critical for interventions such as peripheral nerve stimulation (PNS), nerve blocks, and intrathecal pump placement, the application of VR remains underexplored. This case series examines the role of VR in enhancing pre-procedural planning for complex chronic pain interventions. Methods: From August 2022 to December 2024, six patients with anatomically challenging conditions underwent VR-assisted pre-procedural planning at Weill Cornell Medical Center. Patient-specific 3D models were created using the manual or automatic segmentation of imaging data and reviewed in VR to optimize procedural strategies by the surgeons performing the case. Procedures were then performed using conventional fluoroscopic or ultrasound guidance. Results: In all cases, VR facilitated the improved visualization of complex anatomies and informed optimal procedural trajectories. In patients with a complex cancer anatomy, previous surgical changes, or hardware, VR enabled precise PNS lead or needle placement, resulting in significant pain reductions postoperatively. In certain cases where previous interventional pain procedures had failed, VR allowed for a "second opinion" to develop an alternative approach with improved outcomes. Finally, in one case, VR served to potentially prevent patient harm by providing insight to the proceduralists regarding an alternative approach. Across the series, VR enhanced the spatial awareness, procedural accuracy, and confidence in navigating challenging anatomical scenarios. Conclusions: This case series demonstrates the utility of VR in pre-procedural planning for chronic pain interventions. By enabling detailed anatomical visualization and trajectory optimization, VR has the potential to improve outcomes in complex cases. Further studies are needed to evaluate its broader clinical applications and cost-effectiveness in pain management.

Introduction: Improvements in soft ware, design, and cost reduction have made virtual reality (VR) a practical tool for an immersive, multi-sensory experience to distract patients from painful stimuli. While the utility of VR for pain management has been evaluated among few specific conditions, to our knowledge it has not been tested among hospitalized patients with gastrointestinal (GI) disorders. Herein, we evaluated the clinical utility of VR for inpatient pain management and its effect on blood pressure and heart rate in a cohort of hospitalized patients with a variety of GI disorders. Methods: We screened patients admitted to the inpatient medicine service for GI-related illnesses during a 4-month period. We excluded patients with nausea, vomiting, dementia, motion sickness, stroke, seizure, epilepsy, and those in infectious isolation. Patients with at least one self-reported pain score of three or greater during the 24 hours preceding patient screening were selected to participate in the study. Eligible patients viewed a specific VR experience designed to reduce pain using the Samsung Gear Oculus VR goggles (Figure 1). We then compared pre and post intervention pain scores, blood pressure, and heart rate within subjects.Figure 1Results: A total of 13 patients participated in the study (Table 1). There was a statistically significant reduction in self-reported pain scores post VR intervention compared to before the intervention (pre-VR Mean = 3.8462 vs. post-VR Mean = 3.0000; P = 0.0025) corresponding to a 22% pain reduction and an observed effect size of 1.06 (Table 2). When adjusting for patients who reported no pain prior to VR intervention, similar findings were observed with a larger effect size of 1.83 (pre-VR Mean = 5.5556 vs. post-VR Mean = 4.3333; P = 0.0006). We did not observe a statistically significant change in systolic blood pressure, diastolic blood pressure, or mean heart rate (Table 2). Additionally, patients tolerated the intervention well and did not report any adverse effects.Table 1: Patient CharacteristicsTable 2: Physiological OutcomesConclusion: The use of VR for inpatients with GI disorders resulted in significant improvements in patient-reported pain scores, without influencing blood pressure and heart rate. VR is a potentially safe and practical tool to augment pain management in the acute inpatient setting. Further studies are indicated to further validate these findings, determine which subtypes of GI patients would benefit most from VR, and discover if long-term improvements in patient-reported pain scores are possible.

Background Chronic pain is often a debilitating condition that affects individuals physically and mentally. Reliance on pharmacotherapy for pain management comes with risks of analgesic misuse and dependence. Hence, non-pharmacologic treatment plays a crucial role in pain management. Virtual reality is a novel method in chronic pain management. However, there is little understanding about healthcare providers’ perspectives on the use of virtual reality technology in managing chronic pain. This study aims to explore the current management challenges faced by chronic pain healthcare providers and their perspectives on using virtual reality as adjunctive therapy in managing chronic pain. Method Individual semi-structured interviews were conducted among all chronic pain healthcare providers in a tertiary hospital. The interviews were analysed using qualitative thematic analysis. Results Eight chronic pain healthcare providers participated in this study. Financial issues were cited as one of the biggest barriers to utilisation of non-pharmacological treatment. Participants highlighted the importance of psychosocial support from family and healthcare providers. Challenges identified included absence of patient engagement and lack of awareness about pain management among healthcare providers as well as the lack of an integrated multidisciplinary approach in our healthcare system. Participants were receptive towards the use of virtual reality in chronic pain management and offered ample opinions and suggestions for its application in chronic pain management. Conclusions A multilevel, multifaceted approach is needed to improve chronic pain management. Virtual reality technology could be considered as an adjunct therapy to address some of the challenges and limitations identified in this study.

In recent years, an increased demand for improving mental health and well-being led to developing procedures capable of enhancing positive experiences. One highly attractive candidate for evoking positive experiences is Virtual Reality (VR), as VR enables users to experience various situations in controlled and safe environments. This overview first investigates how positive emotions, well-being and VR are interconnected. Then, an overview about how and why to induce positive emotions in adult users is provided. Methodological and ethical considerations about VR technology, measurements of VR’s efficacy and user characteristics are reviewed. It emerges that VR is efficient in inducing positive emotions across the adult lifespan and in various settings. Levels of immersion, interactivity, Virtual environment contents, sensory modalities involved and users’ characteristics emerged as key determinants for successfully inducing positive emotions with VR. The main applications of positive VR experiences consist in using VR for relaxation, stress and pain management, motivation for physical activities, and gives promising results for apathy treatment in elderly users. Although VR is efficient in eliciting positive emotions and experiences, the underlying operating mechanisms remain unclear and are yet to be further investigated. Finally, the need for a user-centered approach when designing positive VR experiences, clear guidelines for the use of VR, and a better documentation of its potential adverse effects are addressed.

<p>Chronic pain is ongoing pain lasting for long periods after the initial injury or disease has healed. Chronic pain is difficult to treat and can affect the daily lives of patients. Distraction therapy is a proven way of relieving pain for patients by taking their attention away from the pain. Virtual reality is a platform for distraction therapy by immersing the user visually, aurally, and even somewhat physically in a virtual world detached from reality. There is little research done regarding the effects virtual reality's physical interactions have on pain management. This project aims to evaluate different types of virtual reality interactions for chronic pain patients to determine which is most effective for pain relief. The results found that physical and mental activities in virtual reality are equally effective as each other at reducing pain while the patients are engaged in the content, while the effects of observing relaxing content persists outside of virtual reality. These results inform the design of future virtual reality games targeted at pain management.</p>

Virtual reality (VR) and augmented reality (AR) stand on the edge of reality, transforming sectors like gaming, organization management, education, promotions, health services, and veterans' recovery. This chapter meticulously explores their therapeutic potential, underscoring their vital role in mental health assessment. The literature review identifies research gaps and spans applications in rehabilitation, emotional regulation, Autism, ADHD, PTSD, coping skills, cognitive behavioral therapy, stress reduction, pain management, chronic diseases, and mental health apps. A well-crafted entrepreneurial plan addresses technical, physical, social, and financial challenges, integrating ethical considerations, device limitations, cost efficiency, and data security. Forward-looking, it delves into future research trends, estimating their impact on the health industry and pivotal fields, concluding with a summary of transformative prospects in mental health through VR and AR. The future promises enriched well-being via cutting-edge technologies and innovative interventions.

Birth is a normal physiological process, and many women want a natural birth. Women use a range of non-pharmacological pain relief methods to reduce labour pain intensity, to help manage labour pain and to induce relaxation. The purpose of this study was to explore the experiences of women using Virtual Reality as a non-pharmacological method of pain relief in labour. Virtual Reality has been shown to be an effective distraction technique in other acute pain settings which also reduces anxiety. This study conducted qualitative in-depth interviews postnatally with women who used Virtual Reality in labour. Thematic analysis was used to analyse the qualitative data. Nineteen women used Virtual Reality in labour. Results from interviews with nineteen women in the postnatal period identified three main themes: impact of virtual reality on experience of labour, managing the pain of labour and challenges of using virtual reality in labour. This study identified that Virtual Reality was effective as a relaxation technique and helped in pain management by the use of self-efficacy techniques. Women in this study also identified preferred virtual environments specifically to use during labour and birth. This study provides a unique and original contribution to the field of Virtual Reality in labour and birth. It also identifies Virtual Reality as an acceptable and positive experience in the management of anxiety and labour pain.

IntroductionThe management of pain and anxiety remains a challenge in the intensive care unit. By distracting patients, virtual reality (VR) may have a role in painful procedures. We compared VR vs. an inhaled equimolar mixture of N2O and O2 (Kalinox®) for pain and anxiety management during the removal of chest drains after cardiac surgery.MethodsProspective, non-inferiority, open-label study. Patients were randomized, for Kalinox® or VR session during drain removal. The analgesia/nociception index (ANI) was monitored during the procedure for objective assessment of pain and anxiety. The primary endpoint was the ΔANI (ANImin − ANI0) during the procedure, based on ANIm (average on 4 min). We prespecified VR as non-inferior to Kalinox® with a margin of 3 points. Self-reported pain and anxiety were also analysed using numeric rate scale (NRS).Results200 patients were included, 99 in the VR group and 101 in the Kalinox® group; 90 patients were analysed in both groups in per-protocol analysis. The median age was 68.0 years [60.0–74.8]. The ΔANI was − 15.1 ± 12.9 in the Kalinox® group and − 15.7 ± 11.6 in the VR group (NS). The mean difference was, therefore, − 0.6 [− 3.6 to 2.4], including the non-inferiority margin of 3. Patients in the VR group had a significantly higher pain NRS scale immediately after the drain removal, 5.0 [3.0–7.0] vs. 3.0 [2.0–6.0], p = 0.009, but no difference 10 min after. NRS of anxiety did not differ between the two groups.ConclusionBased on the ANI, the current study showed that VR did not reach the statistical requirements for a proven non-inferiority vs. Kalinox® in managing pain and anxiety during chest drain removal. Moreover, VR was less effective based on NRS. More studies are needed to determine if VR might have a place in the overall approach to pain and anxiety in intensive care units.Trial registration NCT, NCT03956264. Registered 20 May 2019, https://clinicaltrials.gov/ct2/show/NCT03956264

Effective pain and stress management during pediatric intramuscular injections is essential, particularly for neonates and young children, who are more sensitive due to developmental factors. This review highlights Non-Pharmacological Interventions (NPIs) designed to reduce procedural pain and distress in children from neonates to adolescents. Preterm neonates are especially vulnerable as their immature neuroregulatory pathways can lead to long-term neurodevelopmental issues if pain is not managed properly. Pediatric intramuscular injections can cause both physiological stress responses and psychological distress, potentially contributing to needle fear and avoidance of healthcare in the future. NPIs such as distraction techniques (e.g., distraction cards, cold-vibration devices and virtual reality), caregiver involvement, comfort positioning and complementary therapies like breastfeeding and oral sucrose have been proven to be safe and effective. These interventions help reduce pain intensity, behavioral distress and physiological stress markers without the side effects of pharmacological treatments. However, gaps remain in understanding the best NPI combinations for different developmental stages, their long-term effects and their use in specific neonatal procedures, such as endotracheal suctioning. Integrating evidence-based NPIs aligns with the principles of atraumatic care, enhancing children's procedural experiences and building trust between healthcare providers, caregivers and patients. To optimize pain management across pediatric populations, future research should focus on age-specific protocols, the use of emerging digital technologies and personalized, multimodal strategies for sustainable pain management. Large-scale studies are needed to explore these aspects further and to refine approaches for pain management in pediatric care.

Background: Patients with advanced breast cancer often experience severe physical and psychological symptoms, including pain. Poor pain management is still prevalent despite the widespread availability of opioids as well as guidelines from the World Health Organization, professional training, and the availability of pain management alternatives. Consequently, researchers and healthcare practitioners have directed their efforts towards non-pharmacological approaches, such as artificial intelligence and virtual reality. Recently, AI technology has been used to develop advanced virtual reality systems that adapt and respond to human behavior in a highly intelligent and interactive manner. Purpose: This study aimed to structure a conceptual framework guided by the Roy Adaptation Model (RAM) for implementing AI-driven immersive VR in managing pain among patients with advanced breast cancer. Methods: A conceptual study framework was structured to use artificial intelligence-driven immersive virtual reality as a novel technology for pain management among patients with advanced breast cancer guided by the (RAM). Results: According to the proposed conceptual framework, it has been determined that healthcare providers can use the structured conceptual framework guided by the Roy Adaptation Model to adapt a nursing-based intervention, such as AI-driven Immersive VR for pain management among patients with advanced breast cancer. Adopting this intervention will help patients achieve a state of adaptation by addressing various modes of adaptation to manage pain, including physiological-physical mode, self-concept mode, role function mode, and independence mode. Conclusion: Roy Adaptation Model (RAM) is a highly valuable conceptual framework that plays a crucial role in guiding the use of artificial intelligence-driven immersive virtual reality as a novel technology for pain management among patients with advanced breast cancer. Implications for Nursing: By utilizing RAM, nurses can enhance their abilities to facilitate effective innovative nursing interventions such as artificial intelligence-driven immersive virtual reality for cancer pain management and to identify all of the related stimuli that directly lead to an increase in the intensity of cancer pain and have a significant influence on the effectiveness of the nursing intervention. Keywords: Breast cancer, Chronic cancer pain, Roy adaptation model, Artificial intelligence-driven immersive virtual reality