Elsevier

Clinical Psychology Review

Volume 30, Issue 8, December 2010, Pages 1011-1018
Clinical Psychology Review

The effectiveness of virtual reality distraction for pain reduction: A systematic review

https://doi.org/10.1016/j.cpr.2010.07.001Get rights and content

Abstract

Virtual reality technology enables people to become immersed in a computer-simulated, three-dimensional environment. This article provides a comprehensive review of controlled research on the effectiveness of virtual reality (VR) distraction for reducing pain. To be included in the review, studies were required to use a between-subjects or mixed model design in which VR distraction was compared with a control condition or an alternative intervention in relieving pain. An exhaustive search identified 11 studies satisfying these criteria. VR distraction was shown to be effective for reducing experimental pain, as well as the discomfort associated with burn injury care. Studies of needle-related pain provided less consistent findings. Use of more sophisticated virtual reality technology capable of fully immersing the individual in a virtual environment was associated with greater relief. Overall, controlled research suggests that VR distraction may be a useful tool for clinicians who work with a variety of pain problems.

Research highlights

►This article provides a comprehensive review of controlled research on the effectiveness of virtual reality (VR) distraction for reducing pain. Eleven studies were identified satisfying inclusion criteria. ►VR distraction was shown to be effective for reducing experimental pain, as well as the discomfort associated with burn injury care. Studies of needle-related pain provided less consistent findings. ►The use of more sophisticated virtual reality technology capable of fully immersing the user in a virtual environment was associated with greater relief.

Introduction

Pain is perhaps the most universal of medical complaints. A recent survey conducted by the Centers for Disease Control found that one in four U.S. adults had suffered a day-long episode of pain in the previous month and one in ten said that the pain had lasted a year or more (National Center for Health Statistics, 2006). Pain can be caused by injury, disease, or invasive medical procedure (e.g., bone marrow aspiration). It can be acute, intermittent, or chronic in nature. The costs to society of pain are staggering. For example, a survey of 28,902 working U.S. adults estimated that lost productive time due to absence and reduced job performance from common pain conditions cost $61.2 billion per year (Stewart, Ricci, Chee, Morganstein, & Lipton, 2003).

A variety of psychological methods have proven to be effective for reducing pain, including cognitive-behavioral procedures (see Butler et al., 2006, Morley et al., 1999) and hypnosis (see Montgomery et al., 2000, Patterson & Jensen, 2003). Distraction is a time-honored psychological pain intervention that has been shown to possess considerable efficacy (see Blount et al., 2003, Dahlquist, 1999a, Dahlquist, 1999b, Powers, 1999). Typical distraction interventions include deep breathing, listening to soothing music, and watching a favorite video. Because humans have finite attentional resources, a distraction task that consumes some portion of those resources is believed to leave less cognitive capacity available for processing pain (McCaul & Malott, 1984).

Of late, there has been growing interest in the use of virtual reality technology as a method of pain reduction (Botella et al., 2008, Gorman, 2006, Riva, 2008). In virtual reality, users interact with a computer-simulated, three-dimensional environment. Virtual reality technology provides multi-sensory information that helps the person to become fully immersed in the simulated world. Users wear a head-mounted display helmet, which is a helmet that provides a stereo visual image, thereby creating a sense of space and depth. A motion tracker in the head-mounted display helmet measures the position of the head and adjusts the visual image accordingly. As a result, users feel as though they can look around and move through the simulated environment. Headphones provide sounds that further help the person to become immersed in the virtual world. Input devices such as joy sticks, wands, and data gloves enable users to move through the simulated environment and to interact with virtual objects.

Until recently, evidence of the effectiveness of virtual reality (VR) distraction for pain reduction came primarily from case materials and studies using a one-group pre-post design. Table 1 summarizes the main characteristics of these studies. For novel psychological interventions, case materials and uncontrolled outcome studies can play an important role in identifying potentially useful avenues of investigation and new methods of clinical practice. However, case studies have limited generalizability and the one-group pre-post design is highly vulnerable to internal validity threats (Campbell & Stanley, 1966).

Not surprisingly, past reviews of research on the use of VR distraction for pain reduction have featured these case materials and uncontrolled studies (e.g., Mahrer & Gold, 2009, Wismeijer & Vingerhoets, 2005). However, during the last few years, there have been a growing number of controlled investigations of the effectiveness of VR distraction for reducing pain. Accordingly, this article provides a comprehensive review of controlled studies of the effectiveness of VR distraction for relieving pain. To our knowledge, this is the first comprehensive review limited to controlled research on the effectiveness of VR distraction for pain reduction.

Section snippets

Method of review

To be included in this review, studies were required to use a between-subjects or mixed model design in which VR distraction was compared with at least one alternative intervention, or a placebo, attention, standard care, or no-treatment control condition in reducing pain. Studies in which audio-visual glasses were used to passively view scenes, thereby failing to provide an opportunity to interact with a computer-simulated environment, were not considered to be examples of virtual reality

Experimental pain

Several studies have evaluated the effectiveness of VR distraction for reducing experimental pain experienced by both adults and children. Hoffman et al. (2006) compared the effectiveness of high-tech and low-tech VR equipment in reducing thermal pain. These investigators hypothesized that greater VR immersion (i.e., an objective, quantifiable index of the nature of the sensory input delivered by a VR system) provided by high-tech equipment would increase presence (i.e., the subjective illusion

Effect sizes of interventions

An effect size (d) was generated for each active intervention in seven of the 11 studies included in this review. Effect size was calculated as the mean difference between an intervention condition and a no-intervention control condition divided by the pooled standard deviation. These standardized effect sizes were then corrected for small sample bias (Hedges & Olkin, 1985) because of the small samples evident in this literature. Effect sizes were not calculated for Leibovici et al., 2009,

Discussion

The findings of controlled research indicate that VR distraction is an effective intervention for reducing experimental pain, as well as the pain associated with burn injury care. Perhaps the strongest evidence of the potency of VR distraction comes from studies of experimental pain. VR distraction was clearly shown to provide relief to adults undergoing thermal pain (Hoffman et al., 2006, Patterson et al., 2006), as well as children experiencing cold pressor pain (Dahlquist et al., 2007,

Conclusions

Ten years ago, Norcross, Hedges, and Prochaska (2002) conducted a Delphi poll on psychotherapy trends expected in the ensuing decade. A panel of 62 psychotherapy experts ranked the use of virtual reality technology 3rd among 38 therapeutic interventions expected to increase the most by 2010. At around the same time, a special issue of Psychotherapy: Theory, Research, Practice, Training forecast that the use of computer technology would be one of the major trends in clinical practice over the

Acknowledgements

This article is based on a psychology honors thesis prepared by Kevin Malloy under the direction of Leonard Milling.

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