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Morris NA, Wang Y, Felix RB, Rao A, Arnold S, Khalid M, Armahizer MJ, Murthi SB, Colloca L. Adjunctive virtual reality pain relief after traumatic injury: a proof-of-concept within-person randomized trial. Pain 2023; 164:2122-2129. [PMID: 37079851 PMCID: PMC10440261 DOI: 10.1097/j.pain.0000000000002914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/10/2023] [Indexed: 04/22/2023]
Abstract
ABSTRACT In this study, we hypothesized that immersive virtual reality (VR) environments may reduce pain in patients with acute traumatic injuries, including traumatic brain injuries. We performed a randomized within-subject study in patients hospitalized with acute traumatic injuries, including traumatic brain injury with moderate pain (numeric pain score ≥3 of 10). We compared 3 conditions: (1) an immersive VR environment (VR Blu), (2) a content control with the identical environment delivered through nonimmersive tablet computer (Tablet Blu), and (3) a second control composed of donning VR headgear without content to control for placebo effects and sensory deprivation (VR Blank). We enrolled 60 patients, and 48 patients completed all 3 conditions. Objective and subjective data were analyzed using linear mixed-effects models. Controlling for demographics, baseline pain, and injury severity, we found differences by conditions in relieving pain (F 2,75.43 = 3.32, P = 0.042). VR Blu pain reduction was greater than Tablet Blu (-0.92 vs -0.16, P = 0.043), but VR Blu pain reduction was similar to VR Blank (-0.92 vs -1.24, P = 0.241). VR Blu was perceived as most effective by patients for pain reduction (F 2,66.84 = 16.28, P < 0.001), and changes in measures of parasympathetic activity including heart rate variability (F 2,55.511 = 7.87, P < 0.001) and pupillary maximum constriction velocity (F 2,61.41 = 3.50, 1-tailed P = 0.038) echoed these effects. There were no effects on opioid usage. These findings outlined a potential clinical benefit for mollifying pain related to traumatic injuries.
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Affiliation(s)
- Nicholas A. Morris
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
- Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD
| | - Yang Wang
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD
| | - Ryan B Felix
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
- Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD
| | - Aniruddha Rao
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD
| | - Shannon Arnold
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
- Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD
| | - Mazhar Khalid
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Sarah B Murthi
- Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD
- Departments of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD
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Coulibaly I, Cardelli LS, Duflos C, Moulis L, Mandoorah B, Nicoleau J, Placide L, Massin F, Pasquié JL, Granier M. Virtual Reality Hypnosis in the Electrophysiology Lab: When Human Treatments Are Better than Virtual Ones. J Clin Med 2022; 11:jcm11133913. [PMID: 35807198 PMCID: PMC9267480 DOI: 10.3390/jcm11133913] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Aims: Virtual reality hypnosis (VRH) has been used successfully in various clinical settings to decrease anxiety and the sensation of pain. We aimed to investigate the feasibility and safety of VRH in patients undergoing electrophysiology and pacing procedures under conscious sedation. Methods: During a two-month period, VRH support was proposed and accepted by 25 patients undergoing electrophysiological procedures. Data were compared with a control group (n = 61) enrolled during the following three-month period. Both groups underwent the measurement of the duration of intervention, the consumption of analgesics and hypnotics, and their pain and comfort using a validated visual analogue scale (VAS 0−10). Results: The baseline characteristics were comparable in both groups, including age. There were no differences in procedure duration (46 (±29) vs. 56 (±32) min, p = 0.18) or in hypnotic/antalgic consumption (midazolam 1.95 (±1.44) vs. 2.00 (±1.22) mg, p = 0.83; sufentanyl 3.78 (±2.87) vs. 3.58 (±2.48) μg, p = 0.9) between the control and VRH groups. In a multivariate analysis, the use of VRH was independently associated with lower comfort during the procedure assessed by postoperative visual analogue scale (OR 15.00 [95% CI 4.77−47.16], p < 0.01). There was no influence of VRH use on pain or drug consumption. Conclusions: In our experience, compared with VRH, human care is preferable during procedures in electrophysiology lab to improve the comfort of the patient. VRH has no influence on pain or drug consumption.
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Affiliation(s)
- Iklo Coulibaly
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
| | | | - Claire Duflos
- Clinical Research and Epidemiology Unit, CHU Montpellier, 34090 Montpellier, France; (C.D.); (L.M.)
- National Institute of Health and Medical Research, Unit 1046, Montpellier University, 34090 Montpellier, France
| | - Lionel Moulis
- Clinical Research and Epidemiology Unit, CHU Montpellier, 34090 Montpellier, France; (C.D.); (L.M.)
- National Institute of Health and Medical Research, Unit 1046, Montpellier University, 34090 Montpellier, France
| | - Bara Mandoorah
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
| | - Jean Nicoleau
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
| | - Leslie Placide
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
| | - François Massin
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
| | - Jean-Luc Pasquié
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
- National Institute of Health and Medical Research, Unit 1046, Montpellier University, 34090 Montpellier, France
| | - Mathieu Granier
- Cardiology Department, CHU Montpellier, 34090 Montpellier, France; (I.C.); (B.M.); (J.N.); (L.P.); (F.M.); (J.-L.P.)
- National Institute of Health and Medical Research, Unit 1046, Montpellier University, 34090 Montpellier, France
- Correspondence:
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Wiechman SA, Jensen MP, Sharar SR, Barber JK, Soltani M, Patterson DR. The Impact of Virtual Reality Hypnosis on Pain and Anxiety Caused by Trauma: Lessons Learned from a Clinical Trial. Int J Clin Exp Hypn 2022; 70:156-173. [PMID: 35348435 PMCID: PMC9248347 DOI: 10.1080/00207144.2022.2052296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This randomized, controlled trial tested the impact that hypnosis delivered through immersive virtual reality technology on background pain, anxiety, opioid use, and hospital length of stay in a sample of patients hospitalized for trauma. Participants were randomly assigned to receive either virtual-reality-induced hypnosis, virtual reality for distraction, or usual care during the course of their hospitalization. Mean number of treatment sessions was 3. A total of 153 patients participated in the study. Results indicated no significant differences between the experimental and control conditions on any outcome measures. This study used an early version of virtual reality technology to induce hypnosis and highlighted several important lessons about the challenges of implementation of this technology and how to improve its use in clinical settings.
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Affiliation(s)
- Shelley A Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Sam R Sharar
- Department of Anesthesiology, University of Washington, Seattle, USA
| | - Jason K Barber
- Department of Neurosurgery, University of Washington, Seattle, USA
| | - Maryam Soltani
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - David R Patterson
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
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Phelan I, Furness PJ, Dunn HD, Carrion-Plaza A, Matsangidou M, Dimitri P, Lindley S. Immersive virtual reality in children with upper limb injuries: Findings from a feasibility study. J Pediatr Rehabil Med 2021; 14:401-414. [PMID: 34151871 PMCID: PMC9108569 DOI: 10.3233/prm-190635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Children who sustain Upper Limb Injuries (ULIs), including fractures and burns, may undergo intensive rehabilitation. The discomfort of therapy can reduce their compliance, limit their range of motion (ROM) and lead to chronic pain. Virtual Reality (VR) interventions have been found to reduce anticipated and procedural pain.This feasibility study aimed to explore perceptions and impacts of a custom-made, fully immersive Head-Mounted Display VR (HMD-VR) experience within a United Kingdom (UK) National Health Service (NHS) outpatient rehabilitation service for children with ULIs. METHODS Ten children aged 9-16 in one UK Children's hospital trialled HMD-VR during one rehabilitation session. They, their parents (n = 10), and hospital physiotherapy staff (n = 2) were interviewed about their perceptions of pain, difficulty, enjoyability, therapeutic impacts, benefits, and limitations. Children rated the sessions on enjoyability, difficulty, and pain compared to usual rehabilitation exercises. Physiotherapists were asked to provide range of motion readings. RESULTS Inductive thematic analysis of interview data generated three themes, 'Escape through Engagement'; 'Enhanced Movement'; and 'Adaptability and Practicality'. Children rated the session as more enjoyable, less difficult and painful than their usual rehabilitation exercises. Findings suggested that HMD-VR was an engaging, enjoyable experience that distracted children from the pain and boredom of therapy. Also, it seemed to enhance the movement they achieved. Participants perceived it was useful for rehabilitation and adaptable to individual needs and other patient groups. Suggestions were made to increase adaptability and build in practical safeguards. CONCLUSION Findings from this small-scale feasibility study suggested HMD-VR was perceived as usable, acceptable, and effective with potential for further development. Future work could include larger scale trials.
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Affiliation(s)
- Ivan Phelan
- Centre for Culture, Media and Society, College of Social Sciences and Arts, Sheffield Hallam University, Sheffield, United Kingdom
| | - Penny J Furness
- Centre for Behavioural Sciences and Applied Psychology (CeBSAP), Department of Psychology, Sociology and Politics, College of Social Sciences and Arts, Sheffield Hallam University, Sheffield, United Kingdom
| | - Heather D Dunn
- Centre for Behavioural Sciences and Applied Psychology (CeBSAP), Department of Psychology, Sociology and Politics, College of Social Sciences and Arts, Sheffield Hallam University, Sheffield, United Kingdom
| | - Alicia Carrion-Plaza
- Centre for Culture, Media and Society, College of Social Sciences and Arts, Sheffield Hallam University, Sheffield, United Kingdom
| | - Maria Matsangidou
- Centre for Culture, Media and Society, College of Social Sciences and Arts, Sheffield Hallam University, Sheffield, United Kingdom
| | - Paul Dimitri
- NIHR Children & Young People MedTech Cooperative, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom.,Sheffield Hallam University, Sheffield, United Kingdom
| | - Shirley Lindley
- Centre for Culture, Media and Society, College of Social Sciences and Arts, Sheffield Hallam University, Sheffield, United Kingdom
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5
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Ioannou A, Papastavrou E, Avraamides MN, Charalambous A. Virtual Reality and Symptoms Management of Anxiety, Depression, Fatigue, and Pain: A Systematic Review. SAGE Open Nurs 2020; 6:2377960820936163. [PMID: 33415290 PMCID: PMC7774450 DOI: 10.1177/2377960820936163] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
In recent years, virtual reality (VR) has become an interesting alternative to traditional exposure-based therapies for many symptoms. VR involves immersion in a computer-generated virtual environment that minimizes avoidance and facilitates emotional processing. The objective of this systematic review is to evaluate evidence on the intervention effect of VR on anxiety, depression, fatigue, and pain. The research strategy of this systematic review included three electronic databases (MEDLINE/PubMed, Cochrane Library, and ScienceDirect) based on predetermined inclusion and exclusion criteria. Published quantitative studies from 2000 to 2020 were identified, which examined the effect of VR intervention on four different symptoms related to symptoms experienced by cancer patients. Quality assessments, data extractions, and analysis were completed on all included studies. A total of 882 titles and abstracts were screened, and 23 studies were included in the review. The studies were grouped according to the symptoms: anxiety and depression, fatigue, and pain. The review showed that VR intervention is more effective compared with the control (i.e., standard care) for anxiety, depression, fatigue, and pain. VR can reduce effectively these symptoms in different contexts and diseases, including cancer. The evidence suggests that there is value in exploring this intervention as a potential crossover treatment for these symptoms in patients. This study contributes to evidence that distraction is an effective symptom management mechanism. The findings are congruent with the theoretical framework, supporting the premise that VR, as an emotion-focused distraction intervention, decreases the severity of these symptoms.
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Affiliation(s)
| | | | - Marios N Avraamides
- Department of Psychology, University of Cyprus.,Silversky3D Virtual Reality Technologies Ltd., Nicosia, Cyprus
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Rousseaux F, Bicego A, Ledoux D, Massion P, Nyssen AS, Faymonville ME, Laureys S, Vanhaudenhuyse A. Hypnosis Associated with 3D Immersive Virtual Reality Technology in the Management of Pain: A Review of the Literature. J Pain Res 2020; 13:1129-1138. [PMID: 32547176 PMCID: PMC7247604 DOI: 10.2147/jpr.s231737] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 02/19/2020] [Indexed: 12/21/2022] Open
Abstract
Hypnosis is well documented in the literature in the management of acute and chronic pain. Virtual reality (VR) is currently gaining credibility in the same fields as hypnosis for medical applications. Lately, the combination of hypnosis and VR was considered. The aim of this scoping review is to understand the current studied contexts and effects of virtual reality hypnosis (VRH) for the management of pain. We searched on PubMed, Taylor & Francis Online, and ProQuest databases with the following terms: “virtual reality,” “3D,” “hypnosis,” and “pain”. We included 8 studies that combined hypnosis and VR. All articles are in English. Two included healthy volunteers and six are clinical studies. Short-term results indicated significant decreases in pain intensity, pain unpleasantness, time spent thinking about pain, anxiety, and levels of opioids. However, results are not consistent for all patients all the days. VR alone seems to reduce pain independently of the hypnotizability level. One study claimed that VR and hypnosis could alter each other’s effects and another argued that VR did not inhibit the hypnotic process and may even facilitate it by employing visual imagery. We cannot affirm that VR added value to hypnosis when they are combined. These trials and case series gave us indications about the possible applications of VRH in different contexts. Additional randomized clinical trials on VRH in the future will have to test this technique in clinical practice and help define guidelines for VRH utilization in pain management.
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Affiliation(s)
- Floriane Rousseaux
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, Liège, Belgium.,Algology Department, University Hospital of Liège, Liège, Belgium.,Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Aminata Bicego
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, Liège, Belgium.,Algology Department, University Hospital of Liège, Liège, Belgium.,Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Didier Ledoux
- Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Intensive Care Units, University Hospital of Liège, Liège, Belgium
| | - Paul Massion
- Intensive Care Units, University Hospital of Liège, Liège, Belgium
| | - Anne-Sophie Nyssen
- Laboratory of Cognitive Ergonomics and Work Intervention, University of Liège, Liège, Belgium.,Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | | | | | - Audrey Vanhaudenhuyse
- Algology Department, University Hospital of Liège, Liège, Belgium.,Sensation & Perception Research Group, GIGA Consciousness, University of Liège, Liège, Belgium
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7
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Harper HE, Hirt PA, Lev-Tov H. The use of virtual reality in non-burn dermatological care - a review of the literature. J DERMATOL TREAT 2020; 33:48-53. [PMID: 32174192 DOI: 10.1080/09546634.2020.1743812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: Virtual Reality (VR) is the artificial depiction of a three-dimensional (3D) environment using computer-generated technology which allows users to interact with a simulated setting. VR has been used in a variety of clinical scenarios due to its efficacy as a distraction intervention, reducing anxiety and pain associated with medical procedures. The aim of this review is to provide clinicians with an overview of VR use in clinical dermatology.Methods: A search on VR use in clinical dermatology was conducted using PubMed Medline, Embase, Cochrane, Google Scholar and ClinicalTrials.Gov in July 2019. Results related to burn care were excluded.Results: This review identifies studies that utilized VR in the management of skin diseases and discusses considerations for its future use.Conclusion: The findings of these studies indicate that VR has beneficial effects as a complementary tool in the treatment of dermatological conditions.
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Affiliation(s)
| | - Penelope A Hirt
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hadar Lev-Tov
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Moon JY, Shin J, Chung J, Ji SH, Ro S, Kim WH. Virtual Reality Distraction during Endoscopic Urologic Surgery under Spinal Anesthesia: A Randomized Controlled Trial. J Clin Med 2018; 8:jcm8010002. [PMID: 30577461 PMCID: PMC6352098 DOI: 10.3390/jcm8010002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 12/03/2022] Open
Abstract
Sedation protocols during spinal anesthesia often involve sedative drugs associated with complications. We investigated whether virtual reality (VR) distraction could be applied during endoscopic urologic surgery under spinal anesthesia and yield better satisfaction than pharmacologic sedation. VR distraction without sedative was compared with pharmacologic sedation using repeat doses of midazolam 1–2 mg every 30 min during urologic surgery under spinal anesthesia. We compared the satisfaction of patients, surgeons, and anesthesiologists, as rated on a 5-point prespecified verbal rating scale. Two surgeons and two anesthesiologists rated the scale and an overall score was reported after discussion. Thirty-seven patients were randomized to a VR group (n = 18) or a sedation group (n = 19). The anesthesiologist’s satisfaction score was significantly higher in the VR group than in the sedation group (median (interquartile range) 5 (5–5) vs. 4 (4–5), p = 0.005). The likelihood of both patients and anesthesiologists being extremely satisfied was significantly higher in the VR group than in the sedation group. Agreement between the scores for surgeons and those for anesthesiologists was very good (kappa = 0.874 and 0.944, respectively). The incidence of apnea was significantly lower in the VR group than in the sedation group (n = 1, 5.6% vs. n = 7, 36.8%, p = 0.042). The present findings suggest that VR distraction is better than drug sedation with midazolam in terms of patient’s and anesthesiologist’s satisfaction and avoiding the respiratory side effects of midazolam during endoscopic urologic surgery under spinal anesthesia.
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Affiliation(s)
- Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Jungho Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea.
| | - Jaeyeon Chung
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea.
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea.
| | - Soohan Ro
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea.
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.
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Jafarizadeh H, Lotfi M, Ajoudani F, Kiani A, Alinejad V. Hypnosis for reduction of background pain and pain anxiety in men with burns: A blinded, randomised, placebo-controlled study. Burns 2018; 44:108-117. [DOI: 10.1016/j.burns.2017.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/28/2017] [Accepted: 06/07/2017] [Indexed: 01/23/2023]
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Pourmand A, Davis S, Lee D, Barber S, Sikka N. Emerging Utility of Virtual Reality as a Multidisciplinary Tool in Clinical Medicine. Games Health J 2017; 6:263-270. [PMID: 28759254 DOI: 10.1089/g4h.2017.0046] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Among the more recent products borne of the evolution of digital technology, virtual reality (VR) is gaining a foothold in clinical medicine as an adjunct to traditional therapies. Early studies suggest a growing role for VR applications in pain management, clinical skills training, cognitive assessment and cognitive therapy, and physical rehabilitation. MATERIALS AND METHODS To complete a review of the literature, we searched PubMed and MEDLINE databases with the following search terms: "virtual reality," "procedural medicine," "oncology," "physical therapy," and "burn." We further limited our search to publications in the English language. Boolean operators were used to combine search terms. RESULTS The included search terms yielded 97 potential articles, of which 45 were identified as meeting study criteria, and are included in this review. These articles provide data, which strongly support the hypothesis that VR simulations can enhance pain management (by reducing patient perception of pain and anxiety), can augment clinical training curricula and physical rehabilitation protocols (through immersive audiovisual environments), and can improve clinical assessment of cognitive function (through improved ecological validity). CONCLUSION Through computer-generated, life-like digital landscapes, VR stands to change the current approach to pain management, medical training, neurocognitive diagnosis, and physical rehabilitation. Additional studies are needed to help define best practices in VR utilization, and to explore new therapeutic uses for VR in clinical practice.
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Affiliation(s)
- Ali Pourmand
- Department of Emergency Medicine, George Washington University , Washington, District of Columbia
| | - Steven Davis
- Department of Emergency Medicine, George Washington University , Washington, District of Columbia
| | - Danny Lee
- Department of Emergency Medicine, George Washington University , Washington, District of Columbia
| | - Scott Barber
- Department of Emergency Medicine, George Washington University , Washington, District of Columbia
| | - Neal Sikka
- Department of Emergency Medicine, George Washington University , Washington, District of Columbia
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11
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Risk of infection and secondary displacement in pediatric supracondylar or lateral condyle fractures treated with unburied Kirchener-wires removed before complete bone healing. J Pediatr Orthop B 2017; 26:222-226. [PMID: 27902636 DOI: 10.1097/bpb.0000000000000417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This study evaluated the risk of infection and of secondary displacement among children with displaced lateral condyle or supracondylar fractures treated by surgery. The study included a consecutive sample of 84 supracondylar fractures and 21 lateral condyle fractures treated with closed reduction and percutaneous pinning. The mean time to Kirchener wire removal was 29 days (range: 25-37 days) postsurgery. Two out of 105 (1.9%) patients developed infectious complications and two of 105 (1.9%) patients had a secondary displacement. Removal of unburied Kirchener wires before complete bone healing in the physician's office does not increase risk of infection or the risk of secondary displacement. The protocol does, however, enable significant savings and eliminates the need for additional anaesthetic.
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Vincent HK, Horodyski M, Vincent KR, Brisbane ST, Sadasivan KK. Psychological Distress After Orthopedic Trauma: Prevalence in Patients and Implications for Rehabilitation. PM R 2015; 7:978-989. [DOI: 10.1016/j.pmrj.2015.03.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/21/2015] [Accepted: 03/07/2015] [Indexed: 02/05/2023]
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13
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Garrett B, Taverner T, Masinde W, Gromala D, Shaw C, Negraeff M. A Rapid Evidence Assessment of Immersive Virtual Reality as an Adjunct Therapy in Acute Pain Management in Clinical Practice. Clin J Pain 2014; 30:1089-98. [DOI: 10.1097/ajp.0000000000000064] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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14
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Loreto-Quijada D, Gutiérrez-Maldonado J, Nieto R, Gutiérrez-Martínez O, Ferrer-García M, Saldaña C, Fusté-Escolano A, Liutsko L. Differential effects of two virtual reality interventions: distraction versus pain control. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2014; 17:353-8. [PMID: 24892197 DOI: 10.1089/cyber.2014.0057] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is evidence that virtual reality (VR) pain distraction is effective at improving pain-related outcomes. However, more research is needed to investigate VR environments with other pain-related goals. The main aim of this study was to compare the differential effects of two VR environments on a set of pain-related and cognitive variables during a cold pressor experiment. One of these environments aimed to distract attention away from pain (VRD), whereas the other was designed to enhance pain control (VRC). Participants were 77 psychology students, who were randomly assigned to one of the following three conditions during the cold pressor experiment: (a) VRD, (b) VRC, or (c) Non-VR (control condition). Data were collected regarding both pain-related variables (intensity, tolerance, threshold, time perception, and pain sensitivity range) and cognitive variables (self-efficacy and catastrophizing). Results showed that in comparison with the control condition, the VRC intervention significantly increased pain tolerance, the pain sensitivity range, and the degree of time underestimation. It also increased self-efficacy in tolerating pain and led to a reduction in reported helplessness. The VRD intervention significantly increased the pain threshold and pain tolerance in comparison with the control condition, but it did not affect any of the cognitive variables. Overall, the intervention designed to enhance control seems to have a greater effect on the cognitive variables assessed. Although these results need to be replicated in further studies, the findings suggest that the VRC intervention has considerable potential in terms of increasing self-efficacy and modifying the negative thoughts that commonly accompany pain problems.
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Affiliation(s)
- Desirée Loreto-Quijada
- 1 Department of Personality, Assessment, and Psychological Treatments, University of Barcelona , Spain
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15
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Abstract
Answer questions and earn CME/CNE Hypnosis has been used to provide psychological and physical comfort to individuals diagnosed with cancer for nearly 200 years. The goals of this review are: 1) to describe hypnosis and its components and to dispel misconceptions; 2) to provide an overview of hypnosis as a cancer prevention and control technique (covering its use in weight management, smoking cessation, as an adjunct to diagnostic and treatment procedures, survivorship, and metastatic disease); and 3) to discuss future research directions. Overall, the literature supports the benefits of hypnosis for improving quality of life during the course of cancer and its treatment. However, a great deal more work needs to be done to explore the use of hypnosis in survivorship, to understand the mediators and moderators of hypnosis interventions, and to develop effective dissemination strategies.
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Affiliation(s)
- Guy H Montgomery
- Integrative Behavioral Medicine Program, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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