Interview with Brennan Spiegel, MD, MSHS
Virtual reality (VR) may be an effective and safe adjunctive therapy for pain management in hospitalized patients, according to findings from a Cedars-Sinai study. 1 Pain scores decreased significantly, regardless of the cause of pain or reason for hospitalization without triggering adverse events or altering vital signs.
Nearly half of hospitalized patients experience pain, and 25% of these patients consider their pain unbearable. 2 Virtual reality (VR) technology has been used in various clinical settings to treat anxiety disorders, support physical rehabilitation, and distract burn patients during wound care. 2-4
“We believe virtual reality hijacks the senses, but in a good way,” Brennan Spiegel, MD, MSHS, director of Cedars-Sinai’s Health Service Research and lead author of the study, told Practical Pain Management. “It creates an immersive distraction that stops the mind from processing pain, offering a drug-free supplement to traditional pain management.”
Rather than focusing on pharmacological management, he noted, clinicians would do well to treat the whole patient, accounting for the psychosocial impact of the illness as well as the physical factors.
Stimulating the Senses to Distraction
In the current study, Dr. Spiegel and his researchers team followed 100 patients with an average pain score of ≥ 3 out of 10 (on a numerical scale) who were evenly divided into 2 groups, in a large, urban teaching hospital.1 Patients in the intervention cohort used a headset to view a 3D-VR experience designed to reduce pain while the control group watched a high-definition, 2D nature video on a bedside screen.
All patients were told that the researchers were testing the effect of a distraction experience on their perception of pain.1 They were asked to rate their pain both before and after the intervention.
While there was a significant drop in pain within both groups, the VR group had a pre-VR mean pain score of 5.4, which decreased by 24% to 4.1 following their 3D experience. The control patients also had a pre-VR mean pain score of 5.4, which decreased by 13.2% to 4.8. When comparing the groups, there were a higher proportion of positive responders in the VR group (65%) versus the control group (40%).1
By stimulating the visual, auditory, and proprioception senses, VR acted as a distraction to limit the user’s processing of nociceptive stimuli,1 according to Dr. Spiegel and his colleagues.
These findings add to the growing body of research on the use of VR in a variety of conditions,4 and suggest that VR has benefits across wide groups of patients.1 In a multivariable regression analysis, the effect of VR was found to be independent of the reasons for hospitalization or primary cause of pain. Confirmation that a single intervention improved pain across diverse conditions suggests a common mechanism for the benefits of VR on pain perception.
Immersive Distraction Works
How VR works to reduce pain is not known exactly, but Dr. Spiegel attributes the benefit to immersive distraction. When the mind is deeply engaged in an immersive experience, it becomes difficult, if not impossible, to perceive other stimuli, including pain, he said.
Because the intervention lasted only 15 minutes and was given only once, it is possible that the patients’ pain may rebound, or that repeated benefits may require a more sustained and repeated exposure to VR content.
“Based on this study, we’re now conducting a larger trial to measure the impact of virtual reality on the use of pain medications, length of hospital stay, and post-discharge satisfaction scores,” Dr. Spiegel said.