Table of Contents
Highlights
- VR is effective in managing acute and chronic pain through the effects of multisensory distraction and neurobiological modulation.
- Postoperative opioid use is reported to be lower with VR use, as it improves recovery and patient satisfaction.
- The limitations concern the study sample size, the usability of the headsets, and the need for long-term and extensive studies.
Virtual reality has been a promising nonpharmacologic pain management intervention that has been increasing in interest due to its ability to enhance pain control with less dependency on conventional pharmaceutical treatment, especially opioids. This assessment discusses the application of Virtual reality for pain treatment and distraction based on its mechanisms, efficacy in different pain conditions, potential as a possible opioid substitute, and present limitations.
Mechanisms of VR Analgesia: Distraction and Neurobiological Changes
The main way in which it is believed to decrease pain is by increased distraction, redirecting a patient’s mind away from painful stimuli. Virtual reality environments often are able to successfully provide an immersive, 3D world through the integration of several technologies, such as head-mounted displays (HMDs), headphones with music/sound, and interaction devices, stimulating multiple senses (visual, auditory, tactile, and in some cases olfactory). This multisensory interaction creates a feeling of “actual presence” in the virtual environment, which differs from passive entertainments such as watching television..
The theoretical basis for VR’s distraction effect includes Melzack and Wall’s “Gate Control Theory,” under which attention and emotion modulate the interpretation of pain, and McCaul and Malott’s extension, in which a limited capacity of attention is proposed such that individuals must pay attention to a stimulus in order for it to be experienced as painful. Wickens’ “Multiple Resources Theory” also assists with this by proposing independently functioning sensory systems, such that Virtual reality can employ multimodal distractions well.
More than just a distraction, virtual reality analgesia has been proposed to involve intercortical modulation among signaling pathways of the pain matrix, impacting attention, emotion, memory, and other senses of the brain to create analgesia. Studies using functional magnetic resonance imaging (fMRI) have demonstrated that Virtual reality can suppress brain activity in areas related to pain, a phenomenon that is also seen with opiate use.
The use of VR seems to influence pain in a way that makes it easier to shift attention away from pain and to the visual system and multisensory integrations. Still, more research is needed to understand its associated neurobiological processes.
VR in Acute Pain Management
A randomized clinical trial involving hospitalized patients after head and neck surgery found that Virtual reality significantly reduced postintervention pain scores and was associated with meaningful reductions in opioid use at both 4 and 8 hours post-intervention. Patients in the VR group showed immediate and sustained reductions in pain scores for up to 3 hours after the intervention, compared to a control group playing a similar 2D game on a smartphone.
This suggests that VR may be a valuable nonpharmacologic adjunct for postoperative pain control. Similar benefits have been observed in pediatric patients after surgery, with Virtual reality reducing both pain and anxiety. VR has also been extensively studied for pain and anxiety attenuation during medical procedures.
Virtual reality is one of the most studied applications for burn care, showing marked effectiveness in the reduction of pain and anxiety during wound care and physical therapy of burn survivors. Specific programs, such as “SnowWorld,” are designed to distract patients by immersing them in cold, icy worlds. A VR system has also been reported to help with chemotherapy, lumbar punctures, port access, and other painful cancer treatments. A “time-elapse compression effect” has been observed where the treatment time felt by the patient is reduced. Likewise, VR has been reported to reduce pain and improve patient, caregiver, and nurse satisfaction for routine blood draws, intravenous placements, and dental procedures.
A Virtual reality system has also been reported to help with chemotherapy, lumbar punctures, port access, and other painful cancer treatments. A “time-elapse compression effect” has been observed where the treatment time felt by the patient is reduced. Likewise, VR has been reported to reduce pain and improve patient, caregiver, and nurse satisfaction for routine blood draws, intravenous placements, and dental procedures.
Virtual Reality in Chronic Pain Management
VR treatments have been effective in dealing with chronic low back as well as neck pain, fibromyalgia, phantom limb pain (PLP), and pain related to cancer. Virtual reality treatments have been effective in dealing with chronic low back as well as neck pain, fibromyalgia, phantom limb pain (PLP), and pain related to cancer.
In phantom limb pain (PLP) cases, VR treatments have been effective than the traditional treatments as the VR provides more advanced manipulation of the virtual limb and is indeed more effective in cases involving amputation of both limbs. VR-based exercise treatments have been reported to be effective for improving the pain and disability scores, as well as patient satisfaction and balance for patients suffering from chronic spinal and neck pain.
Moreover, VR has the potential to enhance well-established methods such as hypnosis and biofeedback for the treatment of chronic pain. In the case of chronic neuropathic pain, studies of VR combined with hypnosis (VRH) have shown an improved degree of treatment effect and also have shown the effects to be lasting for a longer duration, in contrast to hypnosis therapy alone.
VR as a Viable Alternative or Adjunct to Opioids
The randomized clinical trial in patients undergoing head and neck surgery clearly showed a decrease in postoperative use of opioids (expressed in milligram morphine equivalents, MME) among VR users. This is an important result with the risk of narcotic analgesics, such as nausea, sedation, respiratory depression, and possible dependence. Virtual reality is a nonpharmacologic, non-invasive, user-friendly analgesic strategy that does away with systemic side effects and contraindications (e.g., kidney or liver disease) typical of pharmacologic pain medication such as NSAIDs, acetaminophen, and gabapentin.
The direct costs of Virtual reality applications can be minimal, with headsets being reusable and costing once only (e.g., about $400 for an Oculus Quest in one study), thereby presenting a cost-saving potential strategy. Including VR in improved recovery after surgery guidelines can help control pain, minimize the use of opioids, and enhance patients’ hospital quality of life. Through distraction of attention and modulation of pain perception by multisensory stimulation and neurobiological mechanisms, VR differs from analgesics that break pain-transmitting pathways. This makes VR an asset in multimodal analgesia protocols.
Limitations and Future Directions
The results are promising; however, pilot studies have limited sample sizes, which lead to imprecise estimations and hinder strong conclusions. This, paired with the existence of several limitations and future areas of research, has negative effects overall. Issues like a lack of blinding and potential selection bias (patients are more inclined to enjoy gaming) also exist. Though there are attempts in some studies to make similar experiences for Virtual reality and control groups, differences inherent in platforms (e.g., hand controllers with VR) and VR use novelty can impact results.
Particularly in patients with head and neck surgery, the use of Virtual reality is limited due to the incisions or reconstructions they have, which limit the use of a headset. In addition to this, reconstructions have to be in place to use the headset. The use of VR also requires the conduct of larger-scale, high-quality, long-term studies to confirm early observations and assess clinical application of VR in greater detail. Neurobiological mechanisms also require further study in terms of content customization for specific patient needs and conditions, optimal exposure time, and a deeper understanding of.
Research should also investigate the cost-effectiveness of VR and explore its potential in various painful procedures and across different age groups. Assessing outcomes after repeated Virtual reality use is important to determine if the benefits persist beyond the novelty effect. The long-term impact on functional recovery, hospital stays, and quality of life needs further examination.
Conclusion
To sum it all up, Virtual reality has indeed shown a consistent ability to lessen pain and reduce opioid use in a variety of acute and chronic pain situations, and in other routine medical procedures. Because it does not involve medication and is immersive and multisensory, VR has the potential to serve as an effective ‘pain distractor’ and modulator. VR’s potential as a supplement to standard pain management practices and as a substitute for opioids is highlighted by the direct proof of reduced opioid use and the high patient enjoyment ratings.
For now, at least, Virtual reality is going to have a draw, especially since opioid therapy is losing favor. We need larger and more in-depth studies for the evaluation and enhancement of VR’s mechanisms and uses, but the technology is expected to improve the management of acute and chronic pain in the near future, improve patient outcomes, and tackle the public health issue of opioid misuse.
