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Moreau S, Thérond A, Cerda IH, Studer K, Pan A, Tharpe J, Crowther JE, Abd-Elsayed A, Gilligan C, Tolba R, Ashina S, Schatman ME, Kaye AD, Yong RJ, Robinson CL. Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01246-2. [PMID: 38587725 DOI: 10.1007/s11916-024-01246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW This review critically analyzes the recent literature on virtual reality's (VR) use in acute and chronic pain management, offering insights into its efficacy, applications, and limitations. RECENT FINDINGS Recent studies, including meta-analyses and randomized controlled trials, have demonstrated VR's effectiveness in reducing pain intensity in various acute pain scenarios, such as procedural/acute pain and in chronic pain conditions. The role of factors such as immersion and presence in enhancing VR's efficacy has been emphasized. Further benefits have been identified in the use of VR for assessment as well as symptom gathering through conversational avatars. However, studies are limited, and strong conclusions will require further investigation. VR is emerging as a promising non-pharmacological intervention in pain management for acute and chronic pain. However, its long-term efficacy, particularly in chronic pain management, remains an area requiring further research. Key findings highlight that VR programs vary in efficacy depending on the specificity of the origin of pain.
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Affiliation(s)
- Sacha Moreau
- Massachusetts Institute of Technology, Boston, MA, USA
| | - Alexandra Thérond
- Department of Psychology, Université du Québec a Montréal, 100 Sherbrooke St W, Montréal, QC, H2X 3P2, Canada.
| | - Ivo H Cerda
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kachina Studer
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
- Department Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Alicia Pan
- Northeastern University, Boston, MA, USA
| | - Jacob Tharpe
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Jason E Crowther
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Reda Tolba
- Pain Management Department in the Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Sait Ashina
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | | | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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De Miguel-Rubio A, Gallego-Aguayo I, De Miguel-Rubio MD, Arias-Avila M, Lucena-Anton D, Alba-Rueda A. Effectiveness of the Combined Use of a Brain-Machine Interface System and Virtual Reality as a Therapeutic Approach in Patients with Spinal Cord Injury: A Systematic Review. Healthcare (Basel) 2023; 11:3189. [PMID: 38132079 PMCID: PMC10742447 DOI: 10.3390/healthcare11243189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Spinal cord injury has a major impact on both the individual and society. This damage can cause permanent loss of sensorimotor functions, leading to structural and functional changes in somatotopic regions of the spinal cord. The combined use of a brain-machine interface and virtual reality offers a therapeutic alternative to be considered in the treatment of this pathology. This systematic review aimed to evaluate the effectiveness of the combined use of virtual reality and the brain-machine interface in the treatment of spinal cord injuries. A search was performed in PubMed, Web of Science, PEDro, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and Medline, including articles published from the beginning of each database until January 2023. Articles were selected based on strict inclusion and exclusion criteria. The Cochrane Collaboration's tool was used to assess the risk of bias and the PEDro scale and SCIRE systems were used to evaluate the methodological quality of the studies. Eleven articles were selected from a total of eighty-two. Statistically significant changes were found in the upper limb, involving improvements in shoulder and upper arm mobility, and weaker muscles were strengthened. In conclusion, most of the articles analyzed used the electroencephalogram as a measurement instrument for the assessment of various parameters, and most studies have shown improvements. Nonetheless, further research is needed with a larger sample size and long-term follow-up to establish conclusive results regarding the effect size of these interventions.
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Affiliation(s)
- Amaranta De Miguel-Rubio
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain; (I.G.-A.); (A.A.-R.)
| | - Ignacio Gallego-Aguayo
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain; (I.G.-A.); (A.A.-R.)
| | | | - Mariana Arias-Avila
- Physical Therapy Department, Universidade Federal de São Carlos, São Paulo 13565-905, Brazil;
| | - David Lucena-Anton
- Department of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain;
| | - Alvaro Alba-Rueda
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain; (I.G.-A.); (A.A.-R.)
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Moutogiannis PP, Thrift J, Pope JK, Browning MHEM, McAnirlin O, Fasolino T. A Rapid Review of the Role of Virtual Reality in Care Delivery of Palliative Care and Hospice. J Hosp Palliat Nurs 2023; 25:300-308. [PMID: 37822024 DOI: 10.1097/njh.0000000000000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Virtual reality (VR) is an emerging technology that can provide a nonpharmacological approach to symptom management for those with serious illnesses. The VR platform offers a unique perspective to connect patients with places and experiences they might otherwise miss. This rapid review aims to present the current literature on the uses and benefits of VR for palliative care and hospice patients. Through a systematic process, we identified 14 articles published between 2018 and 2023 that used VR as an interventional strategy for symptom management. The VR equipment includes a head-mounted display, such as the Oculus Go, and sometimes requires hand controllers or joysticks. Virtual reality software was contained exclusively in the head-mounted displays or required a laptop. Nature scenes, memorable locations, and the solar system are examples of options patients could select for the VR experience. Assessments of the intervention were measured before, during, after, and several hours afterward to evaluate benefits and potential adverse effects. Pain was the predominant symptom assessed in the studies. Overall, most of the studies focused on establishing the safety, efficacy, and feasibility of VR using a single-arm interventional method. Future research should implement randomized controlled trials, increase sample size, and expand to pediatric populations.
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Persky S, Colloca L. Medical Extended Reality Trials: Building Robust Comparators, Controls, and Sham. J Med Internet Res 2023; 25:e45821. [PMID: 37991836 PMCID: PMC10701646 DOI: 10.2196/45821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/21/2023] [Accepted: 09/17/2023] [Indexed: 11/23/2023] Open
Abstract
The explosive pace of development and research in medical extended reality (MXR) is a testament to its promise for health care and medicine. In comparison with this growth, there is a relative sparsity of rigorous clinical trials that establish the efficacy and effectiveness of these interventions. Explicating mechanisms of action across clinical areas and MXR applications is another major area of need. A primary impediment to these goals is a lack of frameworks for trial design, more specifically, the selection of appropriate controls that effectively address unique elements of MXR. This paper delineates a framework for designing controls, sham conditions, and comparators, as well as proposed considerations for MXR trial designs. Special consideration is given to the design of sham conditions. Improved designs would enable more robust findings and the development of generalizable knowledge that could be adopted across MXR interventions.
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Affiliation(s)
- Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, United States
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland Baltimore, Baltimore, MD, United States
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Koukoulithras I, Alkhazi A, Gkampenis A, Stamouli A, Plexousakis M, Drousia G, Xanthi E, Roussos C, Kolokotsios S. A Systematic Review of the Interventions for Management of Pain in Patients After Spinal Cord Injury. Cureus 2023; 15:e42657. [PMID: 37644939 PMCID: PMC10461890 DOI: 10.7759/cureus.42657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
Chronic pain is a very common problem in patients with spinal cord injury (SCI) as it affects 80% of these patients, which negatively affects their quality of life. Despite many advantages that exist in the management of any type of pain (neuropathic, nociceptive, mixed) in these patients, there is no cure, and the analgesic effect of some treatments is inadequate. This study aims to conduct an evidence-based systematic review regarding the various interventions used for the management of pain after SCI. The PubMed, Physiotherapy Evidence Database (PEDro), and Cochrane Library databases were searched from 1969 to 2023. The risk of bias was assessed using the PEDro scoring system. A total of 57 studies met the inclusion criteria and were included in this systematic review. Among the different interventions at present, 18 studies examined the role of oral medications, 11 studies examined the role of minimally invasive methods (injection and infusion), 16 studies investigated physiotherapy and alternative treatments, and 12 studies examined the role of repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and cranial electrotherapy stimulation (CES) in the management of pain in patients after SCI. Gabapentin and pregabalin are very effective in managing chronic neuropathic pain after SCI, and pregabalin also seems to reduce anxiety and sleep disturbances in the patients. It is noteworthy that lamotrigine, valproate, and carbamazepine do not have an analgesic effect, but mirogabalin is a novel and promising drug. Antidepressants (selective serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors) did not reduce the pain of the patients, although some studies showed an efficacy of amitriptyline especially in depressed patients and tramadol should be considered short-term with caution. Also, tDCS and rTMS reduced pain. Moreover, botulinum toxin type A, lidocaine, ketamine, and intrathecal baclofen significantly reduced pain intensity, although the sample of the studies was small. Physiotherapy and alternative treatments seem to relieve pain, and transcutaneous electrical nerve stimulation had the greatest reduction of pain intensity. In conclusion, several pharmaceutical and non-pharmaceutical methods exist, which can reduce pain in patients after SCI. The type of intervention can be considered by the physician depending on the patients' preference, age, medical history, type of pain, and associated symptoms. However, more studies with greater samples and with better methodological quality should be conducted.
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Affiliation(s)
- Ioannis Koukoulithras
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, GRC
- Faculty of Medicine, University of Ioannina, Ioannina, GRC
| | - Abdulaziz Alkhazi
- Department of Neurosurgery, Mater Dei Hospital, Msida, MLT
- Faculty of Medicine, University of Malta, Imsida, MLT
| | - Athanasios Gkampenis
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, GRC
- Faculty of Medicine, University of Ioannina, Ioannina, GRC
| | - Alexandra Stamouli
- Department of Physical Therapy, University Hospital, University of West Attica, Athens, GRC
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Minas Plexousakis
- Department of Physical Therapy, University Hospital, University of West Attica, Athens, GRC
| | - Gianna Drousia
- Department of Physical Therapy, University Hospital, University of West Attica, Athens, GRC
| | - Eleana Xanthi
- Department of Physical Therapy, University Hospital, University of West Attica, Athens, GRC
| | - Charis Roussos
- Department of Physical Medicine and Rehabilitation, Mitera Hospital, Athens, GRC
| | - Spyridon Kolokotsios
- Department of Physical Therapy, University Hospital, University of West Attica, Athens, GRC
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6
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Miller MI, Shih LC, Kolachalama VB. Machine Learning in Clinical Trials: A Primer with Applications to Neurology. Neurotherapeutics 2023; 20:1066-1080. [PMID: 37249836 PMCID: PMC10228463 DOI: 10.1007/s13311-023-01384-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
We reviewed foundational concepts in artificial intelligence (AI) and machine learning (ML) and discussed ways in which these methodologies may be employed to enhance progress in clinical trials and research, with particular attention to applications in the design, conduct, and interpretation of clinical trials for neurologic diseases. We discussed ways in which ML may help to accelerate the pace of subject recruitment, provide realistic simulation of medical interventions, and enhance remote trial administration via novel digital biomarkers and therapeutics. Lastly, we provide a brief overview of the technical, administrative, and regulatory challenges that must be addressed as ML achieves greater integration into clinical trial workflows.
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Affiliation(s)
- Matthew I Miller
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Ludy C Shih
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA.
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, 02115, USA.
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7
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Chuan A, Hatty M, Shelley M, Lan A, Chow H, Dai E, Haider S, Bogdanovych A, Chua W. Feasibility of virtual reality-delivered pain psychology therapy for cancer-related neuropathic pain: a pilot randomised controlled trial. Anaesthesia 2023; 78:449-457. [PMID: 36734021 DOI: 10.1111/anae.15971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 02/04/2023]
Abstract
Virtual reality-delivered psychological therapies have recently been investigated as non-pharmacological management for acute and chronic pain. However, no virtual reality pain therapy software existed that met the needs of cancer patients with neuropathic pain. We created a bespoke virtual reality-delivered pain therapy software programme to help cancer patients manage neuropathic pain incorporating guided visualisation and progressive muscle relaxation techniques, whilst minimising the risk of cybersickness in this vulnerable patient population. This randomised controlled pilot study evaluated the feasibility, acceptability, recruitment rates and risk of cybersickness of this pain therapy software programme. Clinical outcomes including opioid consumption, pain severity, pain interference and global quality of life scores were secondary aims. Of 87 eligible cancer patients with neuropathic pain, 39 were recruited (47%), allocated to either the intervention (20 patients, virtual reality pain therapy software programme) or control (19 patients, viewing virtual reality videos). Four patients withdrew before the 3-month follow-up (all in the control group). Pre-existing dizziness (Spearman ρ 0.37, p = 0.02) and pre-existing nausea (Spearman ρ 0.81, p < 0.001) were significantly associated with risk of cybersickness in both groups. Patients in the intervention group reported less cybersickness, as well as tolerated and completed all therapy sessions. At 1- and 3-month follow-up, there were trends in the intervention group towards reductions in: oral morphine equivalent daily dose opioid consumption (-8 mg and -4 mg; vs. control: 0 mg and +15 mg respectively); modified Brief Pain Inventory pain severity (-0.4, -0.8; vs. control +0.4, -0.3); and pain interference (-0.9, -1.8; vs. control -0.2, -0.3) scores. The global quality of life subscale from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 was not significantly changed between groups at 1 and 3 months (intervention: -5, -8; vs. control: +3, +4). This newly created virtual reality-delivered pain therapy software programme was shown to be feasible and acceptable to cancer patients with neuropathic pain. These results will aid the design of a definitive multicentre randomised controlled trial.
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Affiliation(s)
- A Chuan
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Department of Anaesthesia, Liverpool Hospital, Sydney, Australia
| | - M Hatty
- BehaviourWorks Australia, Monash University, Melbourne, Australia.,The Mind Room, Melbourne, Australia
| | - M Shelley
- Northern Integrated Pain Management, Newcastle, Australia
| | - A Lan
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - H Chow
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - E Dai
- Department of Medical Oncology, Liverpool Hospital, Sydney, Australia
| | - S Haider
- Department of Medical Oncology, Liverpool Hospital, Sydney, Australia
| | - A Bogdanovych
- MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, Australia
| | - W Chua
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Department of Medical Oncology, Liverpool Hospital, Sydney, Australia
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Manchanda N, Aggarwal A, Setya S, Talegaonkar S. Digital Intervention For The Management Of Alzheimer's Disease. Curr Alzheimer Res 2023; 19:CAR-EPUB-129308. [PMID: 36744687 DOI: 10.2174/1567205020666230206124155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 02/07/2023]
Abstract
Alzheimer's disease (AD) is a progressive, multifactorial, chronic, neurodegenerative disease with high prevalence and limited therapeutic options, making it a global health crisis. Being the most common cause of dementia, AD erodes the cognitive, functional, and social abilities of the individual and causes escalating medical and psychosocial needs. As yet, this disorder has no cure and current treatment options are palliative in nature. There is an urgent need for novel therapy to address this pressing challenge. Digital therapeutics (Dtx) is one such novel therapy that is gaining popularity globally. Dtx provides evidence based therapeutic interventions driven by internet and software, employing tools such as mobile devices, computers, videogames, apps, sensors, virtual reality aiding in the prevention, management, and treatment of ailments like neurological abnormalities and chronic diseases. Dtx acts as a supportive tool for the optimization of patient care, individualized treatment and improved health outcomes. Dtx uses visual, sound and other non-invasive approaches for instance-consistent therapy, reminiscence therapy, computerised cognitive training, semantic and phonological assistance devices, wearables and computer-assisted rehabilitation environment to find applications in Alzheimer's disease for improving memory, cognition, functional abilities and managing motor symptom. A few of the Dtx-based tools employed in AD include "Memory Matters", "AlzSense", "Alzheimer Assistant", "smart robotic dog", "Immersive virtual reality (iVR)" and the most current gamma stimulation. The purpose of this review is to summarize the current trends in digital health in AD and explore the benefits, challenges, and impediments of using Dtx as an adjunctive therapy for the management of AD.
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Affiliation(s)
- Namish Manchanda
- School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences & Research University, Govt. of NCT of Delhi, New Delhi-110017, India
| | - Akanksha Aggarwal
- Delhi Institute of Pharmaceutical Sciences And Research, Delhi Pharmaceutical Sciences & Research University, Govt. of NCT of Delhi, New Delhi-110017, India
| | - Sonal Setya
- Department of Pharmacy Practice, SGT College of Pharmacy, SGT University, Gurugram, Haryana-122505, India
| | - Sushama Talegaonkar
- School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences & Research University, Govt. of NCT of Delhi, New Delhi-110017, India
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Matthie NS, Giordano NA, Jenerette CM, Magwood GS, Leslie SL, Northey EE, Webster CI, Sil S. Use and efficacy of virtual, augmented, or mixed reality technology for chronic pain: a systematic review. Pain Manag 2022; 12:859-878. [PMID: 36098065 PMCID: PMC9517958 DOI: 10.2217/pmt-2022-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/24/2022] [Indexed: 01/11/2023] Open
Abstract
Aim: Characterize use and efficacy/effectiveness of virtual, augmented, or mixed reality (VR/AR/MR) technology as non-pharmacological therapy for chronic pain. Methods: Systematic search of 12 databases to identify empirical studies, of individuals who experience chronic pain or illness involving chronic pain, published between 1990 and 2021. JBI Critical Appraisal Checklists assessed study bias and a narrative synthesis was provided. Results: 46 studies, investigating a total of 1456 participants and including 19 randomized controlled trials (RCT), were reviewed. VR/AR/MR was associated with improved pain-related outcomes in 78% of the RCTs. Conclusion: While most studies showed effects immediately or up to one month post treatment, RCTs are needed to further evaluate VR/AR/MR, establish long-term benefits, and assess accessibility, especially among individuals who experience pain management disparities.
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Affiliation(s)
- Nadine S Matthie
- Nell Hodgson Woodruff School of Nursing, Emory University; Atlanta, GA 30322, USA
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University; Atlanta, GA 30322, USA
| | | | - Gayenell S Magwood
- College of Nursing, Medical University of South Carolina; Charleston, SC 29425, USA
| | - Sharon L Leslie
- Woodruff Health Sciences Center Library, Emory University; Atlanta, GA 30322, USA
| | - Emily E Northey
- Nell Hodgson Woodruff School of Nursing, Emory University; Atlanta, GA 30322, USA
| | | | - Soumitri Sil
- School of Medicine, Emory University; Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta, GA 30322, USA
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Hadjiat Y, Marchand S. Virtual Reality and the Mediation of Acute and Chronic Pain in Adult and Pediatric Populations: Research Developments. FRONTIERS IN PAIN RESEARCH 2022; 3:840921. [PMID: 35599969 PMCID: PMC9120608 DOI: 10.3389/fpain.2022.840921] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/13/2022] [Indexed: 11/28/2022] Open
Abstract
The use of virtual reality (VR) in the mediation of acute pain in adults has shown real benefit to patients for the past 20 years. This review of the literature provides a descriptive synthesis of the types of VR technology, the mechanisms by which VR mediates pain, and a history of early research in the area. A review of the use of VR to mediate chronic pain in adults, and both acute and chronic pain in pediatric populations follows. The studies reviewed provide mixed results and it is noted that many studies have small sample sizes, are case studies, and do not control for extraneous variables such as the dosage and type of VR technology used. Although VR is an exciting area of inquiry that promises to yield multiple applications, there is a necessity to conduct larger random controlled trials to better understand the use cases for which VR is most effective.
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Affiliation(s)
- Yacine Hadjiat
- Department of Surgery, Service of Neurosurgery, French National Institute of Health and Medical Research (Inserm) U987, Paris-Saclay University (EDSP), Paris, France
- *Correspondence: Yacine Hadjiat
| | - Serge Marchand
- Inserm U987, Pharmacology & Physiopathology, University de Sherbrooke University Hospital, Quebec, QC, Canada
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Tran Y, Austin P, Lo C, Craig A, Middleton JW, Wrigley PJ, Siddall P. An Exploratory EEG Analysis on the Effects of Virtual Reality in People with Neuropathic Pain Following Spinal Cord Injury. SENSORS 2022; 22:s22072629. [PMID: 35408245 PMCID: PMC9002545 DOI: 10.3390/s22072629] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
Neuropathic pain in people with spinal cord injury is thought to be due to altered central neuronal activity. A novel therapeutic intervention using virtual reality (VR) head-mounted devices was investigated in this study for pain relief. Given the potential links to neuronal activity, the aim of the current study was to determine whether use of VR was associated with corresponding changes in electroencephalography (EEG) patterns linked to the presence of neuropathic pain. Using a within-subject, randomised cross-over pilot trial, we compared EEG activity for three conditions: no task eyes open state, 2D screen task and 3D VR task. We found an increase in delta activity in frontal regions for 3D VR with a decrease in theta activity. There was also a consistent decrease in relative alpha band (8–12 Hz) and an increase in low gamma (30–45 Hz) power during 2D screen and 3D VR corresponding, with reduced self-reported pain. Using the nonlinear and non-oscillatory method of extracting fractal dimensions, we found increases in brain complexity during 2D screen and 3D VR. We successfully classified the 3D VR condition from 2D screen and eyes opened no task conditions with an overall accuracy of 80.3%. The findings in this study have implications for using VR applications as a therapeutic intervention for neuropathic pain in people with spinal cord injury.
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Affiliation(s)
- Yvonne Tran
- Department of Linguistics, Macquarie University Hearing, Macquarie University, Sydney, NSW 2109, Australia
- Correspondence:
| | - Philip Austin
- Department of Pain Management, HammondCare, Greenwich Hospital Greenwich, Sydney, NSW 2065, Australia; (P.A.); (P.S.)
| | - Charles Lo
- Management Disciplinary Group, Wentworth Institute of Higher Education, Surrey Hills, NSW 2010, Australia;
| | - Ashley Craig
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.C.); (J.W.M.); (P.J.W.)
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - James W. Middleton
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.C.); (J.W.M.); (P.J.W.)
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Paul J. Wrigley
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.C.); (J.W.M.); (P.J.W.)
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Philip Siddall
- Department of Pain Management, HammondCare, Greenwich Hospital Greenwich, Sydney, NSW 2065, Australia; (P.A.); (P.S.)
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.C.); (J.W.M.); (P.J.W.)
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12
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Mattison G, Canfell O, Forrester D, Dobbins C, Smith D, Töyräs J, Sullivan C. The influence of wearables on healthcare outcomes in chronic disease: a systematic review (Preprint). J Med Internet Res 2022; 24:e36690. [PMID: 35776492 PMCID: PMC9288104 DOI: 10.2196/36690] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/19/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chronic diseases contribute to high rates of disability and mortality. Patient engagement in chronic disease self-management is an essential component of chronic disease models of health care. Wearables provide patient-centered health data in real time, which can help inform self-management decision-making. Despite the perceived benefits of wearables in improving chronic disease self-management, their influence on health care outcomes remains poorly understood. Objective This review aimed to examine the influence of wearables on health care outcomes in individuals with chronic diseases through a systematic review of the literature. Methods A narrative systematic review was conducted by searching 6 databases for randomized and observational studies published between January 1, 2016, and July 1, 2021, that included the use of a wearable intervention in a chronic disease group to assess its impact on a predefined outcome measure. These outcomes were defined as any influence on the patient or clinician experience, cost-effectiveness, or health care outcomes as a result of the wearable intervention. Data from the included studies were extracted based on 6 key themes, which formed the basis for a narrative qualitative synthesis. All outcomes were mapped against each component of the Quadruple Aim of health care. The guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement were followed in this study. Results A total of 30 articles were included; studies reported 2446 participants (mean age: range 10.1-74.4 years), and the influence of 14 types of wearables on 18 chronic diseases was presented. The most studied chronic diseases were type 2 diabetes (4/30, 13%), Parkinson disease (3/30, 10%), and chronic lower back pain (3/30, 10%). The results were mixed when assessing the impact on a predefined primary outcome, with 50% (15/30) of studies finding a positive influence on the studied outcome and 50% (15/30) demonstrating a nil effect. There was a positive effect of 3D virtual reality systems on chronic pain in 7% (2/30) of studies that evaluated 2 distinct chronic pain syndromes. Mixed results were observed in influencing exercise capacity; weight; and biomarkers of disease, such as hemoglobin A1c, in diabetes. In total, 155 outcomes were studied. Most (139/155, 89.7%) addressed the health care outcomes component. This included pain (11/155, 7.5%), quality of life (7/155, 4.8%), and physical function (5/155, 3.4%). Approximately 7.7% (12/155) of outcome measures represented the patient experience component, with 1.3% (2/155) addressing the clinician experience and cost. Conclusions Given their popularity and capability, wearables may play an integral role in chronic disease management. However, further research is required to generate a strong evidence base for safe and effective implementation. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021244562; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=244562
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Affiliation(s)
- Graeme Mattison
- Queensland Digital Health Research Network, Global Change Institute, The University of Queensland, Brisbane, Australia
- Metro North Hospitals and Health Service, Brisbane, Australia
- Digital Health Cooperative Research Centre, Australian Government, Sydney, Australia
| | - Oliver Canfell
- Queensland Digital Health Research Network, Global Change Institute, The University of Queensland, Brisbane, Australia
- Digital Health Cooperative Research Centre, Australian Government, Sydney, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- University of Queensland Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Doug Forrester
- Queensland Digital Health Research Network, Global Change Institute, The University of Queensland, Brisbane, Australia
- Metro North Hospitals and Health Service, Brisbane, Australia
| | - Chelsea Dobbins
- Queensland Digital Health Research Network, Global Change Institute, The University of Queensland, Brisbane, Australia
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Daniel Smith
- Metro North Hospitals and Health Service, Brisbane, Australia
| | - Juha Töyräs
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Clair Sullivan
- Queensland Digital Health Research Network, Global Change Institute, The University of Queensland, Brisbane, Australia
- Metro North Hospitals and Health Service, Brisbane, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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13
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Wen J, Piao Y. Human-Computer Interaction-Oriented African Literature and African Philosophy Appreciation. Front Psychol 2022; 12:808414. [PMID: 35069396 PMCID: PMC8776655 DOI: 10.3389/fpsyg.2021.808414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/25/2021] [Indexed: 12/02/2022] Open
Abstract
African literature has played a major role in changing and shaping perceptions about African people and their way of life for the longest time. Unlike western cultures that are associated with advanced forms of writing, African literature is oral in nature, meaning it has to be recited and even performed. Although Africa has an old tribal culture, African philosophy is a new and strange idea among us. Although the problem of “universality” of African philosophy actually refers to the question of whether Africa has heckling of philosophy in the Western sense, obviously, the philosophy bred by Africa’s native culture must be acknowledged. Therefore, the human–computer interaction-oriented (HCI-oriented) method is proposed to appreciate African literature and African philosophy. To begin with, a physical object of tablet-aid is designed, and a depth camera is used to track the user’s hand and tablet-aid and then map them to the virtual scene, respectively. Then, a tactile redirection method is proposed to meet the user’s requirement of tactile consistency in head-mounted display virtual reality environment. Finally, electroencephalogram (EEG) emotion recognition, based on multiscale convolution kernel convolutional neural networks, is proposed to appreciate the reflection of African philosophy in African literature. The experimental results show that the proposed method has a strong immersion and a good interactive experience in navigation, selection, and manipulation. The proposed HCI method is not only easy to use, but also improves the interaction efficiency and accuracy during appreciation. In addition, the simulation of EEG emotion recognition reveals that the accuracy of emotion classification in 33-channel is 90.63%, almost close to the accuracy of the whole channel, and the proposed algorithm outperforms three baselines with respect to classification accuracy.
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Affiliation(s)
- Jianlan Wen
- School of Foreign Languages, Yanbian University, Yanji, China.,School of Foreign Languages, Jilin Institute of Chemical Technology, Jilin, China
| | - Yuming Piao
- School of Foreign Languages, Yanbian University, Yanji, China
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14
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Austin PD, Siddall PJ, Lovell MR. Feasibility and acceptability of virtual reality for cancer pain in people receiving palliative care: a randomised cross-over study. Support Care Cancer 2022; 30:3995-4005. [PMID: 35064330 PMCID: PMC8782583 DOI: 10.1007/s00520-022-06824-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/10/2022] [Indexed: 10/26/2022]
Abstract
CONTEXT Pain management in palliative care remains inadequate; the development of innovative therapeutic options is needed. OBJECTIVES To determine the feasibility and preliminary effectiveness for larger randomised controlled trials of 3D head-mounted (HMD) virtual reality (VR) for managing cancer pain (CP) in adults. METHODS Thirteen people receiving palliative care participated in a single-session randomised cross-over trial, after which they completed a qualitative semi-structured interview. We also compared the effects of 3D HMD VR and 2D screen applications on CP intensity and levels of perceived presence. Feasibility was assessed with recruitment, completion rates and time required to recruit target sample. RESULTS Although recruitment was slow, completion rate was high (93%). Participants reported that the intervention was acceptable and caused few side effects. Although participants reported significantly reduced CP intensity after 3D HMD VR (1.9 ± 1.8, P = .003) and 2D screen applications (1.5 ± 1.6, P = .007), no significant differences were found between interventions (-.38 ± 1.2, 95% CI: -1.1-.29, P = .23). Participants reported significantly higher levels of presence with the 3D HMD VR compared to 2D screen (60.7 ± SD 12.4 versus 34.3 ± SD 17.1, mean 95% CI: 16.4-40.7, P = .001). Increased presence was associated with significantly lower pain intensity (mean 95% CI: -.04--0.01, P = 0.02). CONCLUSIONS Our preliminary findings support growing evidence that both 3D and 2D virtual applications provide pain relief for people receiving palliative care. Given the relative lack of cybersickness and increasing access to portable VR, we suggest that larger clinical studies are warranted.
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Affiliation(s)
- Philip D Austin
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia.
| | - Philip J Siddall
- Department of Pain Management, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia.,Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
| | - Melanie R Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia.,Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
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15
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Austin PD. The Analgesic Effects of Virtual Reality for People with Chronic Pain: A Scoping Review. PAIN MEDICINE 2022; 23:105-121. [PMID: 34260724 DOI: 10.1093/pm/pnab217] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Although virtual reality is shown to have short-term analgesic effects in acute pain settings, its long-term efficacy in chronic pain conditions has not been established. This scoping review aims to provide a summary of virtual reality approaches explored in chronic primary and secondary pain conditions as defined by the International Association for the Study of Pain. METHODS A systematic literature search in Ovid PubMed and Ovid Embase was conducted between January 5 and January 10, 2021, with the use of the Arksey and O'Malley six-step scoping review criteria. Articles were searched via search terms and keywords relating to International Classification of Diseases-defined primary and secondary chronic pain conditions, virtual reality, virtual illusion, distraction, and effects on levels of pain. RESULTS Of the 2,118 articles located, 44 were included, which covered a range of primary and secondary chronic pain conditions and used a variety of different computer screen and headset protocols, including gaming, mindfulness, exercise, relaxation, and proprioceptive skills. CONCLUSIONS Studies show virtual reality to be an effective analgesic intervention for people with chronic pain. Given user satisfaction, a lack of side effects such as cybersickness, and relief of comorbid symptoms, virtual reality has potential as a worthwhile adjunct to chronic pain management programs, thus enabling patients to take control of their symptoms.
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Affiliation(s)
- Philip D Austin
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
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16
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Development and Feasibility Test of a Mouth Contactless Breathing Exercise Solution Using Virtual Reality: A Randomized Crossover Trial. Asian Nurs Res (Korean Soc Nurs Sci) 2021; 15:345-352. [PMID: 34920173 DOI: 10.1016/j.anr.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to develop a novel mouth contactless breathing exercise solution based on virtual reality (VR), and to test its feasibility. METHODS We developed the Virtual Reality-based Breathing Exercise System (VR-BRES), a self-regulating biofeedback breathing exercise with gaming characteristics and a soft stretch sensor. The feasibility and efficacy of the VR-BRES prototype were investigated through a randomized crossover trial. Fifty healthy adults participated in the trial, and their respiratory parameters and user evaluation of the VR-BRES were compared with conventional deep breathing (CDB) exercises. RESULTS The respiratory parameters, forced vital capacity (Z = 4.82, 4.95, p < .001), forced expiratory volume in one second (t = 6.02, 6.26, p < .001), and peak expiratory flow (t = 5.35, 5.68, p < .001) were significantly higher during breathing exercises using the VR-BRES. User evaluation was also significantly higher for the VR-BRES in terms of efficiency (Z = 3.86, p < .001), entertainingness (Z = 5.00, p < .001), and intention to use (Z = 3.22, p = .001) compared to CDB. However, there was no difference in convenience between the two methods (Z = -0.90, p = .369). CONCLUSION The VR-BRES has the potential to be an efficient breathing exercise solution. We recommend a clinical study that evaluates the effects of the VR-BRES for a certain period of time for people who need breathing exercises.
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Abbadessa G, Brigo F, Clerico M, De Mercanti S, Trojsi F, Tedeschi G, Bonavita S, Lavorgna L. Digital therapeutics in neurology. J Neurol 2021; 269:1209-1224. [PMID: 34018047 PMCID: PMC8136262 DOI: 10.1007/s00415-021-10608-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 12/14/2022]
Abstract
Digital therapeutics (DTx) is a section of digital health defined by the DTx Alliance as “delivering evidence-based therapeutic interventions to patients that are driven by software to prevent, manage, or treat a medical disorder or disease. They are used independently or in concert with medications, devices, or other therapies to optimize patient care and health outcomes”. Chronic disabling diseases could greatly benefit from DTx. In this narrative review, we provide an overview of DTx in the care of patients with neurological dysfunctions.
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Affiliation(s)
- G Abbadessa
- Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - F Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), 39012, Naples, Italy
| | - M Clerico
- Clinical and Biological Sciences Department, University of Torino, 10124, Turin, Italy
| | - S De Mercanti
- Clinical and Biological Sciences Department, University of Torino, 10124, Turin, Italy
| | - F Trojsi
- Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - G Tedeschi
- Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - S Bonavita
- Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - L Lavorgna
- Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy.
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18
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Logan DE, Simons LE, Caruso TJ, Gold JI, Greenleaf W, Griffin A, King CD, Menendez M, Olbrecht VA, Rodriguez S, Silvia M, Stinson JN, Wang E, Williams SE, Wilson L. Leveraging Virtual Reality and Augmented Reality to Combat Chronic Pain in Youth: Position Paper From the Interdisciplinary Network on Virtual and Augmented Technologies for Pain Management. J Med Internet Res 2021; 23:e25916. [PMID: 33667177 PMCID: PMC8111507 DOI: 10.2196/25916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/14/2020] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Virtual reality (VR) and augmented reality (AR) interventions are emerging as promising tools in the treatment of pediatric chronic pain conditions. However, in this young field, there is little consensus to guide the process of engaging in the development and evaluation of targeted VR-based interventions. OBJECTIVE The INOVATE-Pain (Interdisciplinary Network on Virtual and Augmented Technologies for Pain management) consortium aims to advance the field of VR for pediatric chronic pain rehabilitation by providing guidance for best practices in the design, evaluation, and dissemination of VR-based interventions targeting this population. METHODS An interdisciplinary meeting of 16 academics, clinicians, industry partners, and philanthropy partners was held in January 2020. RESULTS Reviewing the state of the field, the consortium identified important directions for research-driven innovation in VR and AR clinical care, highlighted key opportunities and challenges facing the field, and established a consensus on best methodological practices to adopt in future efforts to advance the research and practice of VR and AR in pediatric pain. The consortium also identified important next steps to undertake to continue to advance the work in this promising new area of digital health pain interventions. CONCLUSIONS To realize the promise of this realm of innovation, key ingredients for success include productive partnerships among industry, academic, and clinical stakeholders; a uniform set of outcome domains and measures for standardized evaluation; and widespread access to the latest opportunities, tools, and resources. The INOVATE-Pain collaborative hopes to promote the creation, rigorous yet efficient evaluation, and dissemination of innovative VR-based interventions to reduce pain and improve quality of life for children.
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Affiliation(s)
- Deirdre E Logan
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Jeffrey I Gold
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | | | - Anya Griffin
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Maria Menendez
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Vanessa A Olbrecht
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Samuel Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Megan Silvia
- Department of Physical Therapy and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, United States
- Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, MA, United States
| | | | - Ellen Wang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Sara E Williams
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Luke Wilson
- Mighty Immersion, Inc., New York, NY, United States
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