Effectiveness of VR therapy to reduce post-operative pain scores and opioid usage

Kazune J. Matsuoka, BA

Philadelphia College of Osteopathic Medicine

SUMMARY POINTS

• Virtual Reality (VR) is an immersive and interactive experience used for entertainment and therapy.

• VR therapy has been shown to effectively decrease post-op pain scores in various procedures.

• More research is needed on VR therapy to substantiate its effectiveness in analgesia treatments.

ANALYSIS

Background

Virtual reality (VR) is an interactive and immersive interface that allows users to experience environments created by computers in a controlled setting (5). The history of VR is rich, with early precursors of the VR stemming from as early as 1957 with the invention of a multi-sensory machine called Sensorama by Morton Heilig (6). Additionally, inventions such as Headsight in 1961 allowed the first head mounted display for military training purposes, taking into account motion tracking and dual monitor displays (7). With its broad capabilities and applications, VR began to be used for therapy in the 1990’s by psychologists who used VR as a way for prolonged exposure therapy (5). 

With the advancement of VR, its use in the medical field has broadened to include treatments used by acute pain services for the pediatric population, as well as, post surgery treatment for procedures such as laparoscopy, and head and neck surgery (1,2,4). With a large number of patients experiencing high postoperative pain for standard surgical procedures such as laparoscopy, VR therapy presents as a potential analgesic treatment (2,8). 

While VR therapy presents as a novel treatment for postoperative pain, analgesic treatment for postoperative pain is still largely dependent on opioids (1,2,4). As a consequence, however, opioids can be overprescribed and potentially lead to unnecessary diversion (10). Furthermore, side effects such as sedation, dizziness, physical dependence, and constipation present as risks when prescribed (9). Accordingly, non-opioid measures such as VR therapy could be a potential solution to confront these issues. 

Figure 1. Comparisons between surgical subspecialties for postoperative pain. SEE ARTICLE Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934-944. doi:10.1097/ALN.0b013e31828866b3 (8)

Analysis

Postoperative pain is common and largely associated with emotional regulation (3). It is common for patients in the postoperative period to experience anxiety and fear, which can heighten their sense of pain perception and unpleasantness (3). While the exact mechanism of how VR therapy is not clearly understood, a large component of it is distraction (3). As pain perception requires attention, VR therapy is thought to be more effective in distraction due to its immersive properties and vivid virtual environments (3,13). There are multiple studies focused on VR therapy’s effect on pain control. However, there is a lack of studies examining VR therapy’s effectiveness in reducing opioid use post operatively (3). 

Alternatives to opioid medication have been utilized such as nonsteroidal anti-inflammatory drugs, acetaminophen, and gabapentin (10,4). However, there are still risks and limitations involved with the non-opioid medications above due to numerous side effects(4). Thus, to tackle the issue of postoperative pain management while limiting medication use, a clinical trial was done to determine if VR therapy would be an effective non-pharmacological analgesic postoperatively for head and neck surgery. Results of the trial showed clinically meaningful reductions in postoperative pain with the most meaningful decrease happening immediately after VR therapy use (4). Furthermore, the clinical trial showed downward trends of opioid usage following VR therapy.  More studies are needed to give a comprehensible evaluation of VR therapy for postoperative pain management, with this trial being limited in sample size as well as not being able to have blinding due to the nature of the VR equipment (4). However, as a highly enjoyed, relatively cheap, and non pharmacological method of therapy, VR therapy presents as a potent adjunct to pain control in the postoperative setting (4). 

As surgical anxiety can cause complications due to psychological and physiological stress, a clinical experiment was done with VR therapy to test its efficacy in reducing postoperative stress and pain in patients who had undergone cardiac surgery (12). Although complications did occur during the experiment in some of the patients during the VR therapy session, the majority of patients in this experiment reported an overall decrease in level of pain post-therapy (12). As the study was done in real world clinical conditions, the validity of this experiment and its observed data are significant (12). However, it is important to acknowledge that the experiment was an uncontrolled trial, thus caution must be taken to not overestimate the effectiveness of the VR therapy (12). Consequently more studies are needed to confirm the true efficacy of VR therapy in reducing postoperative pain.

While a variety of experiments have shown that VR therapy can reduce postoperative pain, there are still cases in which VR therapy is not an effective method of analgesia. In a randomized control trial studying the effects of VR therapy on total knee arthroplasty patients, it was found that there was no significant reduction in pain scores between the control group and the experimental group (11). The study provides evidence that in the context of total knee arthroplasty, VR therapy is not superior in pain reduction when compared to the traditional methods of rehabilitation (11). More studies are needed to understand the indications for VR therapy as well as its strengths and limitations. 

Discussion

To truly understand the effectiveness of VR Therapy and its mechanism for reducing postoperative pain and reducing opioid usage, more studies are needed. Further studies covering the effect of VR therapy in different types of surgical operations are crucial in understanding which surgeries VR therapy is indicated for. Additionally, controlled studies should be prioritized to help clarify the actual effects of VR therapy. As opioids have a list of side effects and potential risks for addiction, it is crucial to look for non-opioid analgesic options when treating postoperative pain. 

REFERENCES:

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