Photo Credit: Thinkhubstudio
A new study suggests virtual reality pain relief interventions may be effective at reducing pain in hospitalized populations with cancer.
Virtual reality (VR) provides pain relief in various health settings, but few studies investigate its impact on hospitalized patients with cancer. A recent study in Cancer intends to fill that gap. The researchers completed a randomized control trial in which patients received a VR pain relief intervention or a 2D alternative.
While both provided pain relief, the VR intervention was more effective. The researchers also found that pain relief lasted up to 24 hours after the intervention.
“Virtual reality is a relatively new, rapidly developing technology that has capabilities to influence the patient experience in innovative ways,” said Hunter Groninger, MD, in an interview. Dr. Groninger is the director of Palliative Care at MedStar Washington Hospital Center, where the study was conducted, and a professor of medicine at Georgetown University.
Creating the VR and 2D Interventions
This randomized control trial involved 127 patients recruited from MedStar Washington Hospital Center. To be included, patients had to be adults hospitalized with cancer who reported cancer-related pain greater than 4 on a 10-point scale in the previous 24 hours.
Due to the nature of VR, patients with intractable nausea or a history of epilepsy and seizures were excluded. Patients with anatomical cranial structural abnormalities were also ineligible since the condition may interfere with headphone use.
Patients were divided into two groups. One watched a ten-minute 2D guided imagery distraction, and the other experienced ten minutes of immersive VR therapy. “We chose 10 minutes because that time frame fell in the range of previous VR-pain studies,” explained Dr. Groninger, noting that the range was 5 to 30 minutes.
A 2D video of nature with soothing background music and meditation was chosen. NatureTreks VR was used for the VR intervention because it allows users to explore a natural landscape from a standing, fixed, or sitting position. In an interview, Dr. Groninger explained that the two programs were designed to be similar, though the content differed due to the interventions’ modalities.
Both groups were similar in terms of demographics, levels of opioid use, presence of metastasic disease, and other pain management treatments and consultations. All patients continued to receive standard pharmacological pain treatment throughout the intervention.
Dr. Groninger and the team predicted that the VR group would experience lower levels of pain. To test this hypothesis, they analyzed self-reported pain scores before and after the intervention and determined whether changes were sustained for 24 hours.
VR and 2D Impact Pain Relief
Patients self-reported pre- and post-intervention pain using a 1-10 Likert scale. No matter which group they were assigned, most patients reported decreased pain. The mean Likert scale rating in the VR group decreased by 1.4 points after the ten-minute VR experience. For the 2D group, the rating decreased by 0.7.
These ratings were statistically significant. Both interventions were also well-tolerated, and no adverse effects were reported.
Secondary Outcomes
Dr. Groninger and colleagues outlined some secondary outcomes to test in both groups. These included average pain, pain bothersomeness, and satisfaction with pain management in the last 24 hours. Self-reported distress during the past week was also recorded.
There were no differences between patients who received VR or 2D interventions for multiple secondary outcomes. Unaffected variables include average pain in the last 24 hours, self-reported distress, and satisfaction with pain management.
However, the VR group experienced statistically significant reductions in pain bothersomeness and average pain. These findings are consistent with studies exploring the impact of VR on pain management in other populations, such as patients who experienced heart failure.
Implications for Future Research
Along with key findings on pain relief, the researchers surveyed patients on the ease of access to 2D and VR interventions. A total of 3% of patients in the 2D group rated the device as difficult to use, compared to 25% in the VR group. Despite this, 93% in the 2D group and 90% in the VR group reported a willingness to use the device again.
While public perception dictates older adults are unwilling to learn and use new technologies, this study found the opposite: age was not a factor in learning to use or being willing to use VR technology. However, Dr. Groninger and colleagues point out that there is room to improve ease of use.
The VR intervention’s pain relief lasting for 24 hours suggests VR may relieve chronic pain. However, this study doesn’t dive into the impact of multiple VR sessions on chronic pain, and the researchers identified this as an area for future studies.
Other study limitations included a lack of control or placebo group and unanswered questions about whether VR can reduce opioid use or is a complementary intervention.
Despite these limitations, the study’s results indicate VR interventions may effectively relieve pain for hospitalized patients with cancer for up to 24 hours. In an interview, Dr. Groninger concluded, “The management of pain and other symptoms through this safe, easy-to-use, non-pharmacologic intervention should be explored.”
