Virtual reality and pain relief: in-depth scientific studies
In the 2000’s, Hoffman was the first researcher to carry out scientific research and publish the results, highlighting the benefits of VR in alleviating the pain of burn victims during procedural care. Since then, numerous scientific studies have been carried out to demonstrate the positive impact of virtual reality on anxiety and pain management.
Here, we present Hoffman’s initial findings and a compilation of various scientific studies. Each study correlates pain reduction and virtual reality in pediatric patients.
Hoffman, forerunner in the pain VS virtual reality study
During his first studies, he asked 11 patients to play SnowWorld. The aim: to play this immersive virtual reality game while changing their dressings. During the treatment, subjects are immersed in a universe that invites them to take part in snowball fights with characters such as penguins. An analog scale from 0 to 10 is used to assess the impact of the activity on patients’ pain. Results revealed that patients reported significantly less pain with VR gaming. Notably, half of them reported a reduction of up to 41% in their worst pain.
Hoffman, Hunter G., et al. « Virtual Reality Pain Control During Burn Wound Debridement in the Hydrotank ». The Clinical Journal of Pain, vol. 24, no 4, mai 2008, p. 299 304. DOI.org (Crossref), https://doi.org/10.1097/AJP.0b013e318164d2cc
Virtual reality and pain: a visible impact on the brain
On the strength of this discovery, he took his research further. In particular, he discovered that the brain activity of patients benefiting from active VR gaming was significantly lower in the insula, SS2 and thalamus.
Hoffman and his team went beyond the subjective pain reduction of patients using virtual reality. They wanted to check brain activity in response to pain in the presence or absence of this distractor, using several healthy volunteers. The scientists measured brain activity when a moderately painful heat discharge occurred on the soles of the feet. This was done under several conditions:
a control group that received no analgesic,
a group that used the interactive virtual reality snowball battle game, SnowWorld,
a group with opioid administration only,
a final group that received both methods.
In the control group, the scientists noted, as expected, activation in the 5 pain-related regions. Anterior cingulate cortex (ACC), insula, thalamus, primary somatosensory cortex (SS1) and secondary somatosensory cortex (SS2) all activated during pain stimulation. However, the authors found significantly less activation in the insula, SS2 and thalamus when the subject was playing. At the same time, use of the headset reduced the worst pain experienced. In other words, the use of a virtual reality headset led to a subjective reduction in pain, as well as less intense brain activity.
Table comparing RV and opioid use
Hoffman, Hunter G., et al. « The Analgesic Effects of Opioids and Immersive Virtual Reality Distraction: Evidence from Subjective and Functional Brain Imaging Assessments ». Anesthesia & Analgesia, vol. 105, no 6, décembre 2007, p. 1776. journals.lww.com, https://doi.org/10.1213/01.ane.0000270205.45146.db
This scientific research has paved the way for many other scientific studies. All of them confirm the benefits of using virtual reality in pain management. You can find some of them below, classified by theme. Our own studies proving the analgesic effect of active VR are also available.
What impact does VR content have on analgesic efficacy?
Numerous studies have demonstrated the effectiveness of using virtual reality to reduce pain in patients.
But this is only one medium, and the content can be very varied. For example, researchers used 48 healthy individuals. Each received a painful heat stimulus during a virtual reality session. In one case, subjects played the interactive game SnowCanyon using an eye-tracking system. In the other case, the virtual reality session was passive. It consists solely of viewing and exploring the SnowCanyon universe.
Trials were randomized and results were compared between individuals. Pain was analyzed using a graphical rating scale from 0 to 10. It was shown that the absence of virtual reality during painful stimulation had significantly lower pain scores (from worst pain to unpleasant pain) than passive virtual reality. These scores were even significantly lower compared to interactive virtual reality with eye tracking.
In addition, participants reported a significantly stronger illusion of presence in virtual reality (“being there”), during eye-tracking interactive virtual reality. This article therefore concludes that the use of immersive virtual reality is more effective than passive virtual reality.
Pain score comparison table
Al-Ghamdi, Najood A., et al. « Virtual Reality Analgesia With Interactive Eye Tracking During Brief Thermal Pain Stimuli: A Randomized Controlled Trial (Crossover Design) ». Frontiers in Human Neuroscience, vol. 13, 2020. Frontiers, https://www.frontiersin.org/articles/10.3389/fnhum.2019.00467
Playing to soothe pain?
A study was carried out on 40 individuals to understand the impact of using an eye-tracking game for patients with large wounds undergoing painful dressing or clothing changes.
The game involves throwing cakes using the eyes. The scientists studied various socio-demographic and medical factors, as well as the links between pain and use of the game. They found a strong correlation between experiencing intense pain on a daily basis and being changed without this entertainment.
Similarly, a moderate correlation was demonstrated between daily pain and pain during dressing changes in parallel with gaming. This means that playing during this act of care would enable patients to reduce their daily pain.
Kitala, Diana, et al. « Eye-Tracked Computer Games as a Method for Pain Perception Alleviation in Chronic Wound Management ». Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, vol. 40, nᵒ 2, 2022, p. 283‑90. www.termedia.pl, https://doi.org/10.5114/ada.2022.119970
How can VR be used to improve hospital care conditions?
Scientists have highlighted the benefits of using a virtual reality headset in the hospital setting, reducing pain during procedural care. With this in mind, some have asked whether it might be possible to minimize sedative doses during hand surgery under local anesthesia.
Such is the case of A. Faruki and his team, who compared the required dose of anesthetic, pain and length of stay in post-anesthesia care units for 40 patients. The patients were divided into two groups: a control group and a group with access to virtual reality videos designed to promote relaxation, during the operation. The results showed a significant reduction in the preoperative dose of anesthetic (propofol) and length of stay in post-anesthesia care in the virtual reality group (with an average of 53.0 minutes versus 75.0, p = 0.018).
Faruki AA, Nguyen TB, Gasangwa DV, Levy N, Proeschel S, et al. (2022) Virtual reality immersion compared to monitored anesthesia care for hand surgery: A randomized controlled trial. PLOS ONE 17(9): e0272030. https://doi.org/10.1371/journal.pone.0272030
Graph showing the amount of sedative and length of stay in care, according to the control group and the virtual reality group
VR therapy outside the hospital?
Worst pain is 1.7 times less with active VR than without VR, with a difference of 1.5 points compared to using passive VR.”
Ali, Rania R., et al. « Virtual reality as a pain distractor during physical rehabilitation in pediatric burns ». Burns, vol. 48, no 2, mars 2022, p. 303‑08. ScienceDirect, https://doi.org/10.1016/j.burns.2021.04.031
22 children hospitalized with burns took part in a study. The aim was to confirm the impact of virtual reality on pain and rehabilitation.
The researchers divided them into two groups: a control group and a group with access to a virtual reality headset during rehabilitation exercises. This headset allowed the child to escape by being immersed in the 3D video of his or her choice. The doctors then measured pain using a visual analog scale ranging from 0 to 10.
In the control group, the children felt no difference between the pain they experienced before and after treatment. The virtual reality group, on the other hand, showed a 4.2-point reduction with a 95% confidence interval. The researchers also highlighted an improvement in range of motion only for the virtual reality group.
Conclusion: the use of a virtual reality headset resulted in a significant difference between the groups in terms of rehabilitation effectiveness.
What are the effects on children?
Nearly 80 healthy children (aged 6 to 14) took part in an experiment that measured their anxiety level and pressure pain threshold, according to four conditions.
- The first was the control condition. The child faces the scientist and has no other distractions.
- The second condition presents the child with a 2D safari video featuring a variety of animals.
- A third condition takes this video in a 3D format and uses a virtual reality headset.
- Finally, an interactive virtual reality safari game asks the child to take photos of the animals.
The study showed that children had a higher pressure pain threshold and lower anxiety when using a virtual reality headset.
Graph of mean PPT and mYPAS values before and after, according to the four interventions, with vertical lines indicating 95% CI.
Kjeldgaard Pedersen, L., et al. « Virtual Reality Increases Pressure Pain Threshold and Lowers Anxiety in Children Compared with Control and Non‐immersive Control—A Randomized, Crossover Trial ». European Journal of Pain, vol. 27, no 7, août 2023, p. 805‑15. DOI.org (Crossref), https://doi.org/10.1002/ejp.2108
