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A summary of academic literature by appliedVR on virtual reality research around pain management.
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  Literature Overview: Analgesic and Medical Applications 01 APPLIEDVR PAIN MGMT THE OVERVIEW Medical researchers have effectively used immersive virtual reality (meaning 3D, typically interactive digital environ-ments projected through a headset that ully blocks out other visual stimuli) as an analgesic, anxiety reducer, and dis-traction intervention or patients undergoing painul and tedious medical treatments such as chemotherapy or burn wound care. Research has amply shown that distraction—whether with video games, books, or other activities—makes medical treatments easier to handle and more enjoyable or patients. But immersive VR also has the benefit o causing patients to underestimate the length o time spent in treatment, and may be more effective at reducing anxiety and the sensation o pain than other, less ully immersive, methods o distraction. There is some evidence to suggest (and many successul studies done) that indicate this type o distraction is effec-tive with children, who are likely to be highly accepting o, and engaged with, interactive digital technologies. “Presence,” or level o engagement in the virtual world, significantly increases the strength o analgesic and anxiety-reducing effects. Notable Existing Analgesic Applications or Virtual Reality VR acts as a powerul non-pharmacological analgesic and affective pain reduction method during medical treat-ments or patients suffering rom acute pain. Patients report significantly less pain during treatment and therapy when immersed in an interactive VR environment.ã Venipuncture/IV injection:  Children aged 7- 12 (N=20) were either immersed in VR during injection or afer injection. Using the Faces Pain Scale- Revised, which assesses worry and psychological discomort regarding affective pain, chil-dren who participated in VR during their IV placement reported significantly less affective pain compared to children in the control condition i , demonstrating that VR immersions are highly effective at distracting patients rom pain.ã Burn wound range- o- motion physical therapy: Severe burn wound patients (N=54) under 19 engaging in range- o- motion physical therapy interacted with a virtual “SnowWorld” while their physical therapist moved other affected limbs. Subjects reported a 44% decrease in cognitive pain (tolerance), a 32% reduction in affective pain (anxiety and bother), and a 27% reduction in sensory pain while using VR, an effect which did not diminish over multiple treat-ments. ii ã Burn wound dressing and care: Children aged 3- 14 (N=42) using Augmented Reality (AR), a similarly interactive dig-ital distraction method, reported significantly less pain while using AR versus traditional methods o distraction during burn wound care treatments longer than 30 minutes in duration. iii ã Cerebral Palsy physical therapy: Patients with cerebral palsy participating in physical therapy intended to max-imize range o motion and motor control reported 41.2% less pain while using virtual reality during therapy than patients who were not using VR. iv ã With notably smaller sample sizes, research has also been conducted with children who have cerebral palsy participating in rehabilitation exercises, which has shown that interactive VR can increase their postural con-trol and eelings o sel- efficacy. v i “Effectiveness o virtual reality or pediatric pain distraction during IV placement” (Gold et al. 2006)ii “A randomized, controlled trial o immersive virtual reality analgesia during physical therapy or pediatric burn injuries” (Schmitt et al. 2011)iii “The efficacy o an augmented virtual reality system to alleviate pain in children undergoing burns dressing changes: A randomized controlled trial” (Mott et al. 2007)iv “Virtual reality in pediatric rehabilitation: A review” (Parsons et al. 2009)v “Benefits o a virtual play rehabilitation environment or children with cerebral palsy on perceptions o sel efficacy: A pilot study” (Reid et al. 2003) © 2015 AppliedVR LLC All rights reserved.   © 2015 AppliedVR LLC All rights reserved. ã Chemotherapy: Patients who went through a VR distraction during chemotherapy reported significantly lower anxi-ety scores afer treatment, compared to those who had not used VR or a comparable orm o distraction. vi Virtual Environments Developed or use in Pain Management SpiderWorld (1997) and SnowWorld (2003) were both created by Firsthand Technology under the direction o Dr. Hunter Hoffman. vii SpiderWorld was created to help treat serious phobia to spiders. The environment has since been used or patients without spider phobias to provide an immersive experience or distraction during painul medical procedures.SnowWorld was created to distract and soothe patients during treatment or burn wound care. It transports the patient through an icy canyon filled with snowball- hurling snowmen, flocks o penguins, woolly mammoths and other surprises. Patients are drawn in, throwing their own snowballs as they fly through gently alling snow. Ofen, patients become so deeply engaged, they don’t realize their procedure is already over. Features and Advantages o Virtual Reality Distraction Interventions VR serves as an anxiety reducer, even in the long- term when VR is not being used during treatment. ã Adult patients who had used a VR intervention during their first chemotherapy treatment reported significantly reduced anxiety during subsequent chemotherapy treatments, even i VR was not being used during those subsequent treatments. viii VR causes patients to under- estimate the length o time in treatment. ã Adult patients using a VR intervention during chemotherapy treatments underestimated the elapsed time o treatment by 28% on average. The efficacy o VR does not decline afer repeated treatments. ã According to the burn wound range o motion studies cited above, effectiveness o VR in pain reduction remains equally strong across multiple treatments. ix The more immersive, interactive, and high- tech the VR, the more effective it is. ã When comparing interactive VR to “passive” VR (in which the digital environment is merely viewed), adult participants report a 32% greater reduction in time spent thinking about pain and a 75% greater reduction in affective pain (anxiety and bother) using interactive VR. x vi “Virtual Reality: A Distraction Intervention or Chemotherapy” (Schneider et al. 2007) vii For more inormation, visit http://www.VRpain.com viii Ibid. (Schneider et al 2007)ix “Effectiveness o Virtual Reality- Based Pain Control with Multiple Treatments” (Hoffman et al. 2001)x “Interactivity Influences the Magnitude o Virtual Reality Analgesia” (Wender et al. 2009) 02 Literature Overview: Analgesic and Medical Applications APPLIEDVR PAIN MGMT   © 2015 AppliedVR LLC All rights reserved. 03 Patients enjoy using VR during medical treatments, and would like to continue to use it. ã 86% o adult patients using a VR intervention during chemotherapy treatments reported enjoying the distraction intervention, and 82% would use it again during treatment. xi  Universally, across studies with both young and old patients, the majority o patients report wishing to continue to use VR during subsequent treatments. Additional Health- Related Applications to Explore Enhancing surgical and medical training ã Virtual reality training simulations have been developed or medical first responders, allowing trainees to improve situational reactions through practice in a controlled environment. xii Therapeutic treatment or PTSD, body dysmorphia, and other psychological disorders ã VR provides an advantage to traditional cognitive- behavioral therapy (CBT) by allowing participants to “practice” coping mechanisms in realistic environments that may trigger disordered behaviors.ã In a controlled study o obese women (N=211), ExCT (a combination o VR and CBT) was the only treatment out o our types o more common treatments, including traditional CBT alone, that had significantly improved body image satisaction and sel- efficacy afer 6 months. xiii Increasing physical activity and healthy eating behaviors ã Watching a virtual representation o one’s sel (“doppelganger”) engage in exercise in immersive VR increas-es physical activity in the real world. Those who spent five minutes watching their doppelganger running in VR reported engaging in, on average, an hour more o voluntary exercise in a 24- hour period than those who watched a non- doppelganger avatar (resembling someone else) running or those who watched a doppel-ganger avatar loitering. xiv ã A VR immersion that showed reinorcement (changing “weight”) on a doppelganger depending on the par-ticipant’s ood choices during the VR immersion inspired changes in eating behaviors outside o VR. Males ate more candy and emales ate less candy, depending on how highly present (engaged) they were in VR. xv  indicating that high presence in VR can change post- VR behavior, regardless o the directionality o the change. xi Ibid. (Schneider et al. 2007)xii “Medisim: A Prototype VR System or Training Medical First Responders” (Stansfield et al. 1998)xiii “Virtual reality based treatments in eating disorders and obesity: A review” (Ferrer- Garcia et al. 2013zxiv “Virtual Sel- Modeling: The Effects o Vicarious Reinorcement and Identification on Exercise Behaviors” (Fox et al. 2009)xv “Virtual Experiences, Physical Behaviors: The Effect o Presence on Imitation o an Eating Avatar” (Fox et al. 2009) Literature Overview: Analgesic and Medical Applications APPLIEDVR PAIN MGMT
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