VR Pain Relief
Clinical and Scientific Validation
Section 1: Firsthand VR Applications
VR Health Care (2018).Gromala, D., Rose, H., & Ayalasomayajula, F. AIMed Magazine v3, p.62-25. Download PDF
Suggestions for best practices in the creation and implementation of virtual reality applications for health care.
A Pilot Study of the Impact of Repeated Sessions of Virtual Reality on Chronic Neuropathic Pain. International Journal of Virtual Reality, 18(1). Download PDF
VR sessions provided significant pain relief in all treatment sessions with an average of a 66% reduction in pain during the VR session and a 45% reduction in pain immediately after the session. A decrease in pain was reported to last an average of 30 hours after the session.
Randomized, Crossover Study of Immersive Virtual Reality to Decrease Opioid Use During Painful Wound Care Procedures in Adults. Journal of Burn Care and Research, (April), 278–285.Download PDF
[SnowWorld] Immersive VR (IVR) significantly reduced the amount of opioid medication administered during painful wound care procedures when IVR was used compared with no IVR. Two of 15 patients (11%) requested more than 1 opioid rescue dose with IVR and 9 of 15 patients (60%) requested more than 1 rescue dose without IVR.
How VR could break America’s opioid addiction. online in Mosaic.
[Cool!, SnowWorld] Can virtual reality really soothe pain? Jo Marchant meets the doctors who say yes, and who hope this is a solution for the country consuming 80 per cent of the world’s opioid supply: the United States of America.
The Impact of Virtual Reality on Chronic Pain. PLOS ONE 11(12): e0167523. https://doi.org/10.1371/journal.pone.0167523
[Cool!] Study of VR for chronic pain using Firsthand’s COOL!. Pain was reduced from pre-session to post-session by 33%. Pain was reduced from pre-session during the VR session by 60%. Ten participants (33%) reported complete pain relief while doing the virtual reality session. All participants (100%) reported a decrease in pain to some degree between pre-session pain and during-session pain. A head mounted display (HMD) was used with all subjects and no discomfort was experienced. Only one participant noted any side effects.
The Virtual Meditative Walk: Virtual Reality Therapy for Chronic Pain Management. In Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems (CHI ’15). ACM, New York, NY, USA, 521-524. Download PDF
[VMW] Study shows a VR pain relief system integrated with biosensors and a treadmill reduced chronic pain more effectively than the non-VR control condition.
The Virtual Meditative Walk: An Immersive Virtual Environment for Pain Self-modulation Through Mindfulness-Based Stress Reduction Meditation. International Conference on Virtual, Augmented and Mixed Reality, VAMR 2015: Virtual, Augmented and Mixed Reality pp 388-397 Download PDF
[VMW] Proof-of-concept study showing the combination of immersive VR and MBSR meditation pain self-modulation technique proved to be effective for managing chronic pain.
Feasibility of articulated arm mounted Oculus Rift Virtual Reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients. Cyberpsychology, Behavior and Social Networking, 17(6), 397–401. Read Online
[SnowWorld] Significant reductions in pain measures including: worst pain, time thinking about pain, level of pain unpleasantness.
Virtual Reality and Mobius Floe: Cognitive Distraction as Non-Pharmacological Analgesic for Pain Management. Download PDF
[Cool! under the early working title of Mobius Floe] Design white paper of a VR analgesic application.
Effectiveness of Virtual Reality Pain Distraction with Head- ‐ Mounted and Non Head- ‐ Mounted 3D Displays. Unpublished Manuscript. Download PDF
[SnowWorld] VR significantly better than control, HMD vs. non-HMD not significantly different
Effect of virtual reality on adolescent pain during burn wound care. Journal of Burn Care and Research, 35(5), 395–408. Download PDF
[SnowWorld] The VR group reported less pain during wound care than either the passive distraction or standard care group. The VR group was the only group to have an estimated decrease in pain perception from baseline preprocedure pain to procedural pain reported. Adolescents
Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles. The Journal of Trauma, 71(1 Suppl), S125–30. Read Online
[SnowWorld] VR + medication was significantly better than control. Pain reduction was greatest with the patients in the worst pain.
A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns. Burns: Journal of the International Society for Burn Injuries. 2011;37(1):61–68. Read Online
[SnowWorld] “Subjects reported significant decreases (27–44%) in pain ratings during virtual reality. They also reported improved affect (‘‘fun’’) during virtual reality. The analgesia and affect improvements were maintained with repeated virtual reality use over multiple therapy sessions….”These results suggest that immersive virtual reality is an effective nonpharmacologic, adjunctive pain reduction technique in the pediatric burn population undergoing painful rehabilitation therapy. The magnitude of the analgesic effect is clinically meaningful and is maintained with repeated use.”
The effect of virtual reality on pain and range of motion in adults with burn injuries. Journal of Burn Care & Research, 30(5):785–791. Read online
[SnowWorld] “VR reduced all Graphic Rating Scale pain scores (worst pain, time spent thinking about the pain, and pain unpleasantness by 27, 37, and 31% respectively), relative to the no VR condition. – Ninety-seven percent of patients reported zero to mild nausea after the VR session. “
Interactivity influences the magnitude of virtual reality analgesia. Journal of Cyber Therapy Rehabilitation, 2, 27–33. Read at PubMed
[SnowWorld] Results showed more pain reduction during interactive VR than during non-interactive VR. Compared to the non-interactive group, the interactive VR group reported 32% more reduction in time spent thinking about pain, 75% more reduction in pain unpleasantness, 74% more reduction in worst pain, and 47% more increase in fun during VR
Effects of different virtual reality environments on experimental pain rating in post-stroke individuals with and without pain in comparison to pain free healthy individuals. Annual Review of CyberTherapy …, 53–59. Read online
[SnowWorld, Dante, Limbo] All VR conditions decreased pain ratings compared to the control condition. VR appeared to deferentially influence pain rating to both hot and cold stimuli.
Virtual reality pain control during burn wound debridement in the hydrotank. The Clinical Journal of Pain, 24(4), 299–304. doi:10.1097/AJP.0b013e318164d2cc Download PDF
[SnowWorld] VR distraction showed significant reduction in pain for patients experiencing severe to excruciating pain during wound care.
Effects of different virtual reality environments on pain threshold in individuals with pain following stroke. Proceeding of ICDVRAT,2008, ISBN: 0704915006. Download PDF
[SnowWorld, Dante, Limbo] All VR conditions increased pain threshold, and were more engaging than control condition.
Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. Archives of Physical Medicine and Rehabilitation, 88(12 Suppl 2), S43-9. Download PDF
[SnowWorld] All pain ratings were significantly lower during the VR distraction than during non-VR.
The analgesic effects of opioids and immersive virtual reality distraction: evidence from subjective and functional brain imaging assessments. Anesthesia and Analgesia, 105(6), 1776–83, table of contents. Download PDF
[SnowWorld] Combined opioid + VR reduced pain reports more effectively than opioid alone or VR distraction alone, on all subjective pain measures.
Hypnosis delivered through immersive virtual reality for burn pain: A clinical case series. International Journal of Clinical and Experimental Hypnosis, 54(2), 130-142. Download PDF
[SnowWorld Hypnosis Version] VR group showed significant reduction in pain intensity regardless whether it combined with hypnosis or not. Combination of PHS with VR reduced worst pain and unpleasantness more.
Analgesic effects of posthypnotic suggestions and virtual reality distraction on thermal pain. Journal of abnormal psychology, 115(4), 834. Download PDF
[SnowWorld Hynosis Version] Results showed that combination of VR and hypnosis more effectively decreased all GRS pain scores than hypnosis alone.
Virtual reality helmet display quality influences the magnitude of virtual reality analgesia. The Journal of Pain : Official Journal of the American Pain Society, 7(11), 843–50. Download PDF
[SnowWorld] High-Tech-VR helmet group, showed a clinically significant effects on all pain related outcomes during virtual reality.
Modulation of thermal pain-related brain activity with virtual reality: evidence from fMRI. NeuroReport, 15(8), 1245–1248. doi:10.1097/01.wnr.0000127826.73576.91 Download PDF
[SnowWorld] Virtual reality significantly reduced pain-related brain activity in all 5 regions of interest; the anterior cingulate cortex, primary and secondary somatosensory cortex, insula, and thalamus
Manipulating presence influences the magnitude of virtual reality analgesia. Pain, 111(1), 162-168. Download PDF
[SnowWorld] High-Tech-VR helmet group, showed a clinically significant reduction in pain intensity and a stronger presence during VR
Effectiveness of virtual reality-based pain control with multiple treatments. The Clinical Journal of Pain, 17(3), 229–35. Downlaod PDF
[SpiderWorld] There was a significant reduction in all pain ratings while patients immersed in VR during PT. Magnitude of pain reduction did not diminish with repeated use of VR.
Use of virtual reality for adjudicative treatment of adult burn pain during physical therapy: a controlled study. The Clinical Journal of Pain, 16(3), 244-250. Download PDF
[SnowWorld] All pain ratings for all pain measures were significantly lower during VR than in the control condition.
Section 2: General Press References
Virgin Airlines: Read at virgin.com
Champions of meditation in the workplace are growing in number. Now, with new immersive virtual reality technology becoming increasing available, at-desk VR meditation could be the next big thing with employees. Could VR headsets such as the Oculus Rift and Gear VR create a new tribe of virtual meditators, even in the most chaotic of workplaces?
National Public Radio: Read at KQED
Virtual reality is catching on as a tool in medicine. The technology has been used to treat phobias, reduce pain and even help doctors perform surgery. Now virtual reality is being tried as a way to help people with disabilities explore the world that might be difficult or impossible in real life. And it’s happening at a price that’s well within reach.
Time Life: Read at time.com
Imagine leaving a stressful day behind and slipping into a magical forest of calming lights and sounds. That’s the vision of LUMEN, a relaxing virtual reality experience that launches this week through LIFE VR’s new mobile app.
Dan Newman, Principal Analyst of Futurum Research and CEO, Broadsuite Media Group.
Read at NewCo Shift: shift.newco.com
Data from the 2016 Dell Future Workforce Global study shows that millennials expect to work in a “smart office” in the near or immediate future.
66% of workers are open to using AR/VR in the workplace in the near future
77% of millennials are wiling to use AR/VR products at work
Surgery isn’t the only health care application for VR. This industry is capitalizing on virtual tech for a host of other uses, including fear exposure therapy, physical rehabilitation for stroke and paralysis patients, posttraumatic stress disorder treatment, and pain management. One of my favorite examples of VR in health care is when Expedia and St. Jude’s Children’s Research Hospital teamed up to send terminally ill children on VR adventures of a lifetime. VR is literally changing lives.
Read at AdWeek.com
No question the next generation is going to be VR savvy. McDonald’s Sweden is launching a promotion that invites kids to turn Happy Meal boxes into virtual-reality viewers. VR is literally going to be everywhere.
Section 3: Further Scientific References
Pozeg, P., Palluel, E., Ronchi, R., Solca, M., Al-Khodairy, A.-W., Jordan, X., … Blanke, O. (2017). Virtual reality improves embodiment and neuropathic pain caused by spinal cord injury. Neurology, 89(18), 1894–1903. https://doi.org/10.1212/WNL.0000000000004585. Download PDF
The present findings show that VR exposure using multisensory stimulation differently affected leg vs body ownership, and is associated with mild analgesia with potential for SCI neurorehabilitation protocols.
Jin, W., Choo, A., Gromala, D., Shaw, C., Squire, P. (2016). A Virtual Reality Game for Chronic Pain Management: A Randomized, Controlled Clinical Study. Medicine Meets Virtual Reality 22. Edited by J. D. Westwood et al. IOS Press. Read online
Crossover clinical study showed VR reduced pain in 20 chronic pain patients compared to baseline and control groups.
Cho, K. H., Kim, M. K., Lee, H., & Lee, W. H. (2015). Virtual Reality Training with Cognitive Load Improves Walking Function in Chronic Stroke Patients, 273–280. https://doi.org/10.1620/tjem.236.273.Correspondence.
After the 4-week intervention, under both single (VR) and dual task conditions (VR+Cognitive Load), significant improvement on walking function was observed in VRTCL and control groups (P < 0.05). In addition, in the dual task condition, greater improvement on walking function was observed in the VRTCL group, compared with the control group (P < 0.05).
Sulea, C., Soomro, A., Boyd, C., & Wiederhold, B. K. (2014). Pain Management in Virtual Reality: A Comprehensive Research Chart. Cyberpsychology, Behavior, and Social Networking, 17(6), 402–413. https://doi.org/10.1089/cyber.2014.1514 Download PDF
a comprehensive listing of re- search done on pain management in virtual reality. MEDLINE was searched in October 2013 for the keywords
‘‘virtual reality and pain.’’
Herrero, R., García-Palacios, A., Castilla, D., Molinari, G., & Botella, C. (2014). Virtual reality for the induction of positive emotions in the treatment of fibromyalgia: a pilot study over acceptability, satisfaction, and the effect of virtual reality on mood. Cyberpsychology, Behavior and Social Networking, 17(6), 379–84. doi:10.1089/cyber.2014.0052 Download PDF
Results showed significant increases in general mood state, positive emotions, motivation, and self-efficacy. These preliminary findings show the potential of VR as an adjunct to the psychological treatment of such an important health problem as chronic pain.
Loreto-Quijada, D., Gutiérrez-Maldonado, J., Nieto, R., Gutiérrez-Martínez, O., Ferrer-García, M., Saldaña, C., & Liutsko, L. (2014). Differential effects of two virtual reality interventions: distraction versus pain control. Cyberpsychology, Behavior and Social Networking, 17(6), 353–8. doi:10.1089/cyber.2014.0057 Download PDF
Pain control was more effective than simple distraction.
Tanja-Dijkstra, K., Pahl, S., White, M. P., Andrade, J., Qian, C., Bruce, M., Moles, D. R. (2014). Improving dental experiences by using virtual reality distraction: a simulation study. PloS One, 9(3), e91276. doi:10.1371/journal.pone.0091276 Download PDF
The VR distraction had effects not only on concurrent experiences, such as perceived control, but longitudinally upon the vividness of memories after the dental experience had ended. Participants with higher dental anxiety (for whom the dental procedures were presumably more aversive) showed a greater reduction in memory vividness than lower dental-anxiety participants. “This study thus suggests that VR distractions can be considered as a relevant intervention for cycles of care in which people’s previous experiences affect their behaviour for future events.”
Czub, M., & Piskorz, J. (2014). How Body Movement Influences Virtual Reality Analgesia? 2014 International Conference on Interactive Technologies and Games, 13–19. doi:10.1109/iTAG.2014.8 Download PDF
Found that using a Kinect for large motor movement in VR reduced pain better than small motor movement with a mouse.
Wiederhold, B. K., Gao, K., Sulea, C., & Wiederhold, M. D. (2014). Virtual reality as a distraction technique in chronic pain patients. Cyberpsychology, Behavior and Social Networking, 17(6), 346–52. Download PDF
Chronic pain patients demonstrated significant relief in subjective ratings of pain that corresponded to objective measurements in peripheral, noninvasive physiological measures.
Melzack, R., & Katz, J. (2013). Pain. Wiley Interdisciplinary Reviews: Cognitive Science, 4(1), 1–15. https://doi.org/10.1002/wcs.1201. Download PDF
Neuromatrix theory of pain: Pain is not simply the end product of a linear sensory transmission system; it is a dynamic process that involves continuous interactions among complex ascending and descending systems. The neuromatrix theory guides us away from the Cartesian concept of pain as a sensation produced by injury, inflammation, or other tissue pathology and toward the concept of pain as a multidimensional experience produced by multiple influences
Furman, E., Jasinevicius, T. R., Nabil, F., Victoroff, K. Z., Skillicorn, R., & Buchner, M. (2013). Virtual Reality Distraction for Pain Control During Periodontal Scaling and Root Planing Procedures. Journal of the American Dental Association, (JADA 2009;140(12):1508-1516. Download PDF
Paired t tests revealed that VAS scores were sig- nificantly lower during VR compared with the movie (P < .001) and control (P < .001) conditions. Similarly, BP and PR were lowest during VR, followed by the movie and control conditions. Patients reported that they preferred the VR condition.
Ramachandran V.S.,& Seckel E.L. (2013). Using mirror visual feedback and virtual reality to treat fibromyalgia. Medical Hypotheses 2013; 75:495–496. Download PDF
Reductions in pain and associated anxiety.
Gordon, N. S., Merchant, J., Zanbaka, C., Hodges, L. F., & Goolkasian, P. (2011). Interactive gaming reduces experimental pain with or without a head mounted display. Computers in Human Behavior, 27(6), 2123–2128. doi:10.1016/j.chb.2011.06.006 Download PDF
VR superior to Emotion Induction Task and no difference between tracked HMD and Projector at same (low) FOV
Dahlquist, L. M., Weiss, K. E., Clendaniel, L. D., Law, E. F., Ackerman, C. S., & McKenna, K. D. (2009).. Effects of videogame distraction using a virtual reality type head-mounted display helmet on cold pressor pain in children. Journal of Pediatric Psychology, 34(5), 574–84. doi:10.1093/jpepsy/jsn023 Download PDF
There was a significant increase in pain tolerance and pain threshold in both passive and interactive distraction. Distraction helmet showed more effect.
Cole J., Crowle S., Austwick G., Henderson B., Slater D. (2009). Exploratory findings with virtual reality for phantom limb pain; from stump motion to agency and analgesia. Disabil Rehabil 31(10):846–854 Download PDF
Found that when movements of the virtual limb correspond to capture motion data measured on the patient’s stump instead of the opposite remaining limb, it allows the patients to gain agency for the movement they see, and feel embodied within the limb
Mühlberger, A., Wieser, M. J., Kenntner-Mabiala, R., Pauli, P., Wiederhold, B. K., Muhlberger, A., … Wiederhold, B. K. (2007). Pain modulation during drives through cold and hot virtual environments. Cyberpsychology & Behavior : The Impact of the Internet, Multimedia and Virtual Reality on Behavior and Society, 10(4), 516–22. https://doi.org/10.1089/cpb.2007.9996 Download PDF
” Both VR environments reduced pain for heat and cold pain stimuli when compared to the control. No significant changes in measures of Cyber sickness were detected.”
Dahlquist, L. M., McKenna, K. D., Jones, K. K., Dillinger, L., Weiss, K. E., & Ackerman, C. S. (2007). Active and passive distraction using a head-mounted display helmet: Effects on cold pressor pain in children. Health Psychololgy. 26(6), 794-801. Download PDF
” either passive or interactive distraction caused improvements in both pain tolerance and threshold. Interactive distraction was more effective than the passive.”
Gold, J. I., Kim, S. H., Kant, A. J., Joseph, M. H., & Rizzo, A. S. (2006). Effectiveness of virtual reality for pediatric pain distraction during IV placement. CyberPsychology & Behavior, 9(2), 207-212. Download PDF
All outcome scores were reduced for children in the VR group. No simulator sickness.
Magora, F., Cohen, S., Shochina, M., & Dayan, E. (2006). Virtual reality immersion method of distraction to control experimental ischemic pain. Israel Medical Association Journal, 8, 261–265. Download PDF
Pain components were significantly lower in VR. Tolerance time in VR was significantly longer than No VR.
Gold J.I., Reger G., & Rizzo A.A., et al. (2005). Virtual reality in outpatient phlebotomy: evaluating pediatric pain distraction during blood draw. Presented at the 10th Annual Poster Session of the Saban Research Institute. Los Angeles: Children’s Hospital Los Angeles; The Journal of Pain 6(3), Supplement , Page S57, March 2005. Download Abstract
Lower frequency of moderate to severe pain intensity in VR via HMD
Wolitzky K., Fivush R., Zimand E., Hodges L., & Rothbaum B.O. (2005). Effectiveness of virtual reality distraction during a painful medical procedure in pediatric oncology patients. Psychology & Health, 20(6):817–824. Download PDF
Areas covered include stroke rehabilitation (upper and lower extremity training, spatial and perceptual-motor training), acquired brain injury, Parkinson’s disease, orthopedic rehabilitation, balance training, wheelchair mobility and functional activities of daily living training, and the newly developing field of telerehabilitation. Four major findings emerge from these studies:
(1) people with disabilities appear capable of motor learning within virtual environments;
(2) movements learned by people with disabilities in VR transfer to real world equivalent motor tasks in most cases, and in some cases even generalize to other untrained tasks;
(3) in the few studies (n = 5) that have compared motor learning in real versus virtual environments, some advantage for VR training has been found in all cases; and
(4) no occurrences of cybersickness in impaired populations have been reported to date in experiments where VR has been used to train motor abilities.
Lee, D. W. H., Chan, A. C. W., Wong, S. K. H., Fung, T. M. K., Li, A. C. N., Chan, S. K. C., Chung, S. C. S. (2004). Can visual distraction decrease the dose of patient-controlled sedation required during colonoscopy? A prospective randomized controlled trial. Endoscopy, 36(03), 197-201. Download PDF
The mean pain score and the dose of sedative medication required in group 2 was significantly lower compare to group 1 and 3. Notably, Visual distraction alone did not decrease the dose of sedative medication required for colonoscopy. When audio distraction was added, both the dose of sedative medication required and the pain score decreased significantly. Both visual and audiovisual distraction might improve patients’ acceptance of colonoscopy.
Melzack, R. (1999). From the gate to the neuromatrix. Pain, 82(1), S121–S126. https://doi.org/10.1016/S0304-3959(99)00145-1. Download PDF
Neuromatrix theory of pain: We have traveled a long way from the psychophysical concept that seeks a simple one-to-one relationship between injury and pain. We now have a theoretical framework in which a genetically determined template for the body-self is modulated by the powerful stress system and the cognitive functions of the brain, in addition to the traditional sensory inputs. 6 1999 International Association for the Study of Pain.
Ramachandran, V. S., & Rogers-Ramachandran, D. (1996). Synaesthesia in phantom limbs induced with mirrors. Proceedings. Biological Sciences / The Royal Society, 263(1369), 377–386. Download PDF
Phantom limb pain reduced using a “virtual reality box”.