"Virtual reality produces a modulating effect that is endogenous, so the analgesic influence is not simply a result of distraction but may also impact how the brain responds to painful stimuli," said Jeffrey I. Gold, Ph.D., associate professor of anesthesiology and pediatrics, Keck School of Medicine, University of Southern California and director of the Pediatric Pain Management Clinic at Children's Hospital of Los Angeles. "The focus is drawn to the game not the pain or the medical procedure, while the virtual reality experience engages visual and other senses."
While moderating a symposium entitled "Virtual Reality and Pain Management," Dr. Gold noted that the exact mechanistic/neurobiological basis responsible for the VR analgesic effect of video games is unknown, but a likely explanation is the immersive, attention-grabbing, multi-sensory and gaming nature of VR. These aspects of VR may produce an endogenous modulatory effect, which involves a network of higher cortical (e.g., anterior cingulate cortex) and subcortical (e.g., the amygdale, hypothalamus) regions known to be associated with attention, distraction and emotion. Studies measuring the benefit of virtual reality pain management, therefore, have employed experimental pain stimuli, such as thermal pain and cold pressure tests, to turn pain responses on and off as subjects participate in virtual reality experiences.
"In my current NIH-funded study, I am using functional magnetic resonance imaging (fMRI) to measure the effects of VR on experimental pain," Dr. Gold explained. "The objective is to measure the cortical regions of interest involved in VR, while exposing the participant to video racing games with and without experimental pain stimuli."
Lynnda M. Dahlquist, Ph.D., a clinical child psychologist and professor of psychology at the University of Maryland, Baltimore County, reviewed her most recent laboratory research studies examining the use of virtual reality and other computer/videogame technologies to provide distraction-based acute pain management.
The use of video games and virtual reality distraction (VRD) technology for procedural pain management in both pre-schoolers and elementary to middle school children, reported Dr. Dahlquist, yielded promising results in increasing pain tolerance "with potentially significant future clinical applications for more effective pain reduction techniques for youth with chronic and acute pain. However, more research is needed to know for certain if there is real world VRD application in such pain-generating procedures as cleansing wounds, cancer treatment, immunization, injections and burn care."
Children interacting with a virtual environment by watching video games demonstrated a small pain tolerance improvement during exposure to ice cold water stimulation, according to Dr. Dahlquist, but she recorded significantly greater pain tolerance for kids wearing specially-equipped video helmets when they actually interacted with the virtual environment.
"Our aim is to know what about VRD makes it effective in pain tolerance lab studies with children and what are the best ways to use it for optimum results," explained Dr. Dahlquist, noting that any distraction is better than none at all in pain minimization. "Is it just the amazing graphics in the video games or is it because youngsters are truly more distracted through their direct interaction with the virtual environment?"
VRD's impact on pain tolerance levels varied by children's ages, indicating that age may influence how effective video game interaction will be. "We must better understand at what ages VRD provides the greatest benefit in moderating acute pain and at what age, if any, that it can be too much or be limiting."
In one study using video helmets for virtual environment interactivity, the special equipment had little positive impact with children ages six to ten, but for those over ten years of age, "there was a much longer tolerance of the pain of the cold water exposure, leading us to further study to determine what aspect or aspects of cognitive development and neurological function account for this difference among youth.
"Having dealt clinically for more than 15 years with children with acute and chronic illness," Dr. Dahlquist summed up, "my genuine hope is that virtual reality activity can alleviate the anxiety of approaching pain and the pain experience itself."
American Pain Society
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