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Managing the Pain of Medical Procedures With Virtual Reality

Managing the Pain of Medical Procedures With Virtual Reality 1024 572 Mary Bates, PhD

Clinicians across departments pilot a virtual reality game for pediatric pain management, moving virtual reality closer to clinical standard practice.

A recent pilot study from researchers at Nationwide Children’s Hospital demonstrated the benefits of a virtual reality (VR) game during potentially painful procedures in different clinical settings. Providers and patients reported positive feedback to the intervention, suggesting that VR could be implemented more broadly to help manage pediatric pain and anxiety around medical procedures.

Henry Xiang, MD, MPH, PhD, MBA, is the founding director of the Center for Pediatric Trauma Research at Nationwide Children’s and senior author of the study. Dr. Xiang and his team developed the VR game as a non-pharmacological pain management tool for children during outpatient burn dressing changes. It consisted of a fun, child-appropriate VR game hosted on an iPhone and displayed on a VR headset. In previous studies, the team found that patients engaging with the VR game reported experiencing less pain and anxiety during burn dressing changes. In addition, providers reported that the VR game was easy to use and helpful during these procedures.

Dr. Xiang and colleagues worked to make the system lightweight, portable and inexpensive, and thus practical for different clinical settings. But the researchers were aware that for novel interventions such as VR, the road from research to clinical implementation can take decades.

“To shorten the time to real-world translation, we needed to test the feasibility and validity of our VR game in clinical practice,” says Dr. Xiang, who also directs the Pilot Translational and Clinical Studies Program at the National Institutes of Health (NIH)-funded Ohio State University Clinical and Translational Science Institute.

After demonstrating the safety and efficacy of VR for pain alleviation during burn dressing changes, Dr. Xiang and team were approached by other providers at Nationwide Children’s interested in trialing VR in their clinics.

In the new study, doctors and nurses in Nationwide Children’s emergency department, Plastic Surgery Clinic and Orthopedic Clinic reported their experiences using the VR game with children and teens undergoing needlesticks or pin-pulling procedures. For ease of use, the app was transferred from an iPhone onto a standalone headset (PICO Neo3 Pro Eye). Each clinic received a VR PICO headset pre-loaded with the immersive VR game. The research team’s involvement was limited to assisting with any questions or problems if they arose, says Helen Girin, BA, who was a research assistant in Dr. Xiang’s lab and is a coauthor of the study.

“The goal was to see if this was feasible to implement in a clinic setting without help from the researchers,” Girin says. “Could someone just grab the VR system off the shelf, place it on a child and continue with their clinically relevant procedure without adding time or barriers?”

After each procedure, providers completed a survey on the VR system’s ease of use and effectiveness.

“The clinicians had very positive feedback about the VR game,” says Girin. “It didn’t add more time to the procedures, and it wasn’t burdensome for them to use. There was only one small technical problem that was quickly resolved.”

During semi-structured interviews, many providers noted that patients using VR had an easier time with their procedures.

“We did not ask specifically about anxiety,” says Megan Armstrong, MPH, Clinical Research Coordinator Team Lead at the Center for Pediatric Trauma Research at Nationwide Children’s and a coauthor of the study. “But the clinicians told us that the procedures went faster and were easier to accomplish with the VR headset because their perceived anxiety was lower for those patients.”

The interviews also revealed challenges encountered by the clinicians. For example, the VR game seemed to work best with younger children; some teenagers and those with more video game experience felt the game was too easy and needed more gamification to engage them fully. Providers also noted that a small percentage of patients did not want their eyes covered and preferred to watch the procedure.

Another suggestion to come out of the interviews was that nurses, or other providers who spend more time with patients, may be better suited to implement the VR intervention than doctors.

“Making sure it’s the right person in charge of implementing the game and ensuring that there is a lot of enthusiasm and confidence in the intervention — these are important to create long-term change,” says Armstrong.

The research team report continued and expanded use of their VR game system at Nationwide Children’s since this study. Providers in the Orthopedic Clinic are continuing to use the system to ease pain and anxiety during procedures, and the emergency department physicians who participated in the study are further investigating the use of VR in their department. Dr. Xiang’s team is also collaborating with the Dermatology department and Blood Draw Lab to determine how the VR game might help their patients through painful or anxiety-inducing procedures. The team believes that VR could be helpful in many additional applications.

“When we talk about patient outcomes, people think of length of hospital stay or maybe a physiological measurement,” says Dr. Xiang. “But pain and anxiety are also very important outcomes that do not get considered enough. Developing digital technologies such as VR could really improve patient experience and satisfaction, while also reducing the use of opioids and pain medications in children.”

 

Reference:

Girin H, Armstrong M, Bjorklund KA, Murphy C, Samora JB, Chang J, Scherzer DJ, Xiang H. Implementation of Virtual Reality Pain Alleviation Therapeutic into Routine Pediatric Clinical Care: Experiences and Perspectives of Stakeholders. J Med Ext Real. 2024 Sep 26;1(1):179-185. doi: 10.1089/jmxr.2024.0018.

Image credit: Nationwide Children’s

About the author

Mary a freelance science writer and blogger based in Boston. Her favorite topics include biology, psychology, neuroscience, ecology, and animal behavior. She has a BA in Biology-Psychology with a minor in English from Skidmore College in Saratoga Springs, NY, and a PhD from Brown University, where she researched bat echolocation and bullfrog chorusing.

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