Immersive and Non-Immersive Virtual Reality Distraction on Pain Perception to Intraoral Injections

OBJECTIVE

To evaluate the efficacy of immersive VR (IVR) and non-immersive VR (NIVR) distraction on perceived pain during intraoral injections in children undergoing dental procedures. The objective was to introduce 3-dimensional nature of virtual reality during the provoking phase of dental treatment as a means of distraction in children.

STUDY DESIGN

A total of 200 children were selected for the study, 100 for IVR group and 100 for NIVR group. After randomization, children were introduced to Oculus Go Standalone equipment; MCDAS (f), VAS, WBFRS and the treatment procedure using tell show do technique. Group I children were introduced to oculus go standalone headset with hand held controller to play temple run or roller coaster game while in group II, children watched cartoon movies of their choice. Pre-operative & post-operative MCDAS scores were obtained using MCDAS (f) questionnaire in local language. Post-operatively, VAS and WBFRS scores were also obtained. The data was analyzed using independent t-test and chi-square analysis.

RESULTS

Pre-operatively, the mean MCDAS scores were similar in both the groups viz. Group-I (29.20 ± 3.197) and Group-II (29.09 ± 3.803) and is statistically not significant. Post-operatively, the mean MCDAS scores were higher in non-immersive group (20.72 ± 2.822) as compared to immersive group (10.99 ± 2.227). VAS score was higher in non-immersive group (2.72 ± 0.99) as compared to immersive group (0.75 ± 0.88). WBFRS scores were higher in non-immersive group (2.78 ± 1.097) as compared to immersive group (0.82 ± 1.104).

CONCLUSION

Three-dimensional virtual reality was found to be an effective means of distraction in children undergoing dental procedures and especially during the provoking phase. The significant difference obtained clearly indicates irrespective of immersiveness of virtual reality, anxiety had been decreased and on comparison the pain perception to intraoral injection is less in immersive virtual reality environment. Immersive VR distraction technique can serve as an adjunct to traditional behavior management strategies already available to the pediatric dentist.

Pain Reduction after Short Exposure to Virtual Reality Environments in People with Spinal Cord Injury

Emerging literature suggests that virtual reality (VR) may be a viable therapy for neuropathic pain (NP). This pilot study aimed to investigate the immediate effect of VR in reducing NP in people with spinal cord injury (SCI). Eight individuals with chronic NP after SCI were recruited and underwent consecutive exposure to scenery and somatic virtual environments (VE). The numeric rating scale (NRS) was used to assess pain before and after exposure to each VE. The Immersive Tendencies Questionnaire (ITQ) and Presence Questionnaire (UQO-PQ) were used to investigate the interaction between reported pain relief post-intervention with immersion and presence. There was a significant reduction in pain levels (5.1 ± 0.4, mean ± SEM) after short exposure to the scenery (3.1 ± 0.7, p = 0.04) and somatic VE (3.0 ± 0.7, p = 0.04), with no difference between intervention types (p = 0.56). There was a statistically significant negative correlation between the total ITQ score and the change in NRS after the scenery VR intervention (r_s = 0.743, p = 0.035). PQ scores showed no significant correlation with changes in pain following either intervention type. We found that short-term exposure to VR environments results in a reduction in chronic NP intensity in people with SCI.

Feasibility of a Computer Role-Playing Game to Promote Empathy in Nursing Students: The Role of Immersiveness and Perspective

Empathy is considered a cornerstone of high-quality health care and a required element of nursing education. Although computer role-playing games (CRPGs) are a promising tool to promote clinical empathy, little is known about how and why it is effective at improving empathy. The goal of the current study is to investigate the feasibility and effectiveness of a CRPG on nursing students' empathy with a focus on immersiveness and perspective. Results from a 2 × 2 (virtual reality [VR] vs. non-VR × patient's family's perspective vs. health care provider's perspective) between-subjects experiment (N = 69) showed that playing the game in VR (vs. non-VR) led to greater spatial presence and empathy. Moreover, playing from the health care provider's (vs. patient's family's) perspective elicited greater empathy. A moderated mediation effect was found, suggesting that users' attention allocation significantly mediated the effect of immersiveness on empathy in the patient's family's perspective condition. These findings show the feasibility of using a role-playing game for nursing education. Both theoretical and practical implications involving empathy training were discussed, along with suggestions for further research.

INTERACTIVITY INFLUENCES THE MAGNITUDE OF VIRTUAL REALITY ANALGESIA

Despite medication with opioids and other powerful pharmacologic pain medications, most patients rate their pain during severe burn wound care as severe to excruciating. Excessive pain is a widespread medical problem in a wide range of patient populations. Immersive virtual reality (VR) distraction may help reduce pain associated with medical procedures. Recent research manipulating immersiveness has shown that a high tech VR helmet reduces pain more effectively than a low tech VR helmet. The present study explores the effect of interactivity on the analgesic effectiveness of virtual reality. Using a double blind design, in the present study, twenty-one volunteers were randomly assigned to one of two groups, and received a thermal pain stimulus during either interactive VR, or during non-interactive VR. Subjects in both groups individually glided through the virtual world, but one group could look around and interact with the environment using the trackball, whereas participants in the other group had no trackball. Afterwards, each participant provided subjective 0-10 ratings of cognitive, sensory and affective components of pain, and the amount of fun during the pain stimulus. Compared to the non-interactive VR group, participants in the interactive VR group showed 75% more reduction in pain unpleasantness (p < .005) and 74% more reduction in worst pain (p < .005). Interactivity increased the analgesic effectiveness of immersive virtual reality.