Immersive Virtual Reality (VR) technologies have continued to evolve over the past 20 years, showing their utility in a variety of clinical settings. Now, the use of VR is being increasingly seen as a way to reduce levels of pain and distress during minor medical procedures, without the use of drugs like opioids (Grassini, 2022).
Why use VR for pain management?
The use of VR as an analgesic (pain relieving) procedure is primarily based on the fact that the perception of pain requires attentional resources. However, humans have limited attentional capacity (Kahneman, 1973). Being immersed and interacting with a virtual world offers a unique opportunity to attract a substantial amount of the patient’s limited controlled attentional resources (Hoffmann et al., 2011), leaving less attention available to process incoming pain signals.
The distractive, hypoalgesic (pain relieving) effects of VR are assumed to result from a competition for limited shared attentional resources between the immersive and interactive properties of VR and incoming nociceptive (pain-related) signals (Gupta et al., 2018). Drawing the patients’ attention away from a painful or annoying stimulus and focusing it in a relaxing virtual world, is an evidence-based intervention that has been proved to be largely effective and safe to mitigate the experience of pain and anxiety in patients undergoing painful or disturbing procedures (Chan et al., 2018; Kenney & Milling, 2016; Malloy & Milling, 2010; Mallari et al., 2019; Georgescu et al., 2020; Scheffer et al., 2018; Trost et al., 2021). In addition, some studies have already indicated a linear relationship between the sense of being inside a virtual environment (an illusion that is usually called “sense of presence”) and the effectiveness of VR distraction analgesia (Hoffman et al., 2003; Hoffman et al., 2004a).
The above-mentioned studies imply that:
• An immersive VR world has more efficacy than a non-immersive 2D experience (e.g. watching films or pictures)
• A multi-sensorial experience (e.g. providing visual, auditory and olfactory stimulation) can induce a higher analgesic effect than experiences that stimulate fewer sensorial channels.
• An interactive VR experience is more effective than a passive virtual world.
Studies have also demonstrated that exposure to VR environments reduces pain-related activity in the five regions of the brain associated with pain processing (anterior cingulate cortex, primary and secondary somatosensory cortex, insula, and thalamus) (Hoffman et al., 2004b). Thus, nowadays there is robust scientific evidence showing that VR is a safe, convenient, accessible, and effective strategy to reduce negative emotions during painful and unpleasant procedures.
Applications of VR as an analgesic for acute pain
VR has started to be used by patients of all ages to improve the patient experience and to provide an immersive method of distraction and relaxation during painful or uncomfortable procedures. Nowadays, different randomized controlled studies have confirmed the safety and efficacy of VR as an analgesic (pain-relieving) tool, showing its efficacy in six main clinical settings:
• Adults undergoing burn care, either for dressing change
• Procedures involving needles like blood draw and other intravenous procedures
• Pediatric oncological patients undergoing port access procedures and adults under chemotherapy treatments
• Surgical procedures during labor and delivery or total knee and total hip arthroplasty
• Dental treatments
• Experimentally induced pain
In general, current research studies are demonstrating that VR-based distraction interventions for procedural pain, compared to the most common procedures, can be effective in: 1) Reducing the affective and cognitive components of pain and 2) Decreasing negative emotions like anxiety and distress. However, despite those promising results, most of the existing studies are still based on small trials (Georgescu et al., 2020). In the future, larger studies need to be conducted, using more accessible VR devices, and to compare its efficacy with the most traditional methods of distraction.
One of the most common medical procedures in hospital settings is inserting a peripheral intravenous catheter or needle. This procedure is mainly used for therapeutic purposes such as the delivery of medications, drugs, fluids, and blood products (Catudal, 1999). However, it can cause high levels of distress and pain. For example, patients with conditions such as myasthenia gravis, multiple sclerosis and other neuromuscular disorders can spend up to eight hours receiving this kind of service for their condition.
Beyond clinical scenarios, intravenous procedures have also grown in relevance and popularity as an alternative way to provide micronutrients (such as vitamins, minerals, etc.) to the general population. Today, a growing number of wellness companies are promoting the transformative effects of intravenous therapy for general detoxification, vitality, and improved overall health and wellness.
In both hospital and non-clinical settings, failure to manage anxiety and pain during infusion therapy causes difficulties for healthcare providers in completing their procedures and reduces success rates (Parker et al., 2017). In addition, the experience of negative feelings increases fear, and avoidance of future intravenous and needle-related procedures (Birnie et al., 2018). However, a variety of studies have already proved the strong analgesic effect of VR during intravenous procedures, resulting in a better experience and more satisfied patients:
• Mitigate anxiety and pain during infusion-related procedures
• Reduce the levels of anxiety and pain in cancer patients undergoing peripheral intravenous catheter or cannulation
• Increase first-attempt IV success, patient comfort, or to reduce patient’s anxiety and pain during an intravenous placement in a pediatric emergency department.
• Facilitate pain control during an intravenous placement for a magnetic resonance imaging/computed tomography scan
• Intravenous self-administered sedation during orthopedic surgery
Relax VR for pain and distress management
Relax VR combines exposure to virtual natural scenes, guided meditations, binaural beats and organic essential oils to enhance the user’s positive emotions and decrease distressing thoughts and emotions. It has a number of unique features that makes it an effective and reliable resource for reducing the levels of pain and discomfort in medical and non-clinical settings:
• It provides a multi-sensory experience, by stimulating the user’s visual, auditory and olfactory senses. Multi-sensorial experiences increase the sense of presence and, as a consequence, maximize the analgesic effect .
• Simulator sickness symptoms are rarely experienced while users are immersed in 360º videos. The experience of simulator sickness could increase the user’s levels of pain, anxiety, and distress.
• Scientific evidence has demonstrated the effectiveness of binaural beats as a non-pharmacological procedure for pain management.
• The use of essential oils is effective in reducing the levels of acute pain.
Recent research studies have shown the efficacy of Relax VR to reduce the levels of acute pain in clinical settings (Ju In Chan et al., 2020) and in the general population (Krainbuhl et al., in press). Scientific studies have also proved its utility to reduce negative emotions in hospital scenarios like intensive care units (Ong et al., 2020), palliative care settings (Callistus Nwosu et al., 2021), cardiac rehabilitation units (Maciołek et al., 2020) and pre-operative contexts (Ju In Chan et al., 2020).
The above-mentioned studies suggest that Relax VR can be a good non-pharmacological analgesic for pain management during procedures that are usually associated with pain, distress or discomfort.