Journey Into Virtual Reality Eases Cancer Pain

Immersive virtual reality (VR) as distraction therapy provided relief for hospitalized cancer patients with moderate to severe pain, a single-center randomized trial showed.

Among patients with pain related to their malignancy or treatment, a 10‐minute VR intervention — where users can explore natural environments like beaches or forests — led to clinically and statistically significant reductions in self-reported pain scores compared with an active control, reported researchers led by Hunter Groninger, MD, of the MedStar Health Research Institute and Georgetown University School of Medicine in Washington, D.C., in Cancer.

Immediately after the intervention, data analysis of 127 randomized patients showed an average decrease of 1.4 points in the VR arm on a 0-to-10 Likert Scale (where 0 indicates no pain and 10 represents the worst possible pain) compared with a decrease of 0.7 points in the arm assigned to the active control (P=0.03), which involved a two-dimensional guided-imagery experience with meditation, background music, and natural landscapes on a handheld tablet.

“In both arms, distraction therapy seemed to help in the immediate sense of reducing pain severity, but it reduced it significantly more in the VR arm,” Groninger told MedPage Today.

“What was really interesting to us is that when we went back the next day and resurveyed all the participants on their pain severity, those randomized to the VR arm still had persistently low pain compared to the control arm. There was almost like a sustained analgesic benefit,” he added.

Specifically, Groninger and his colleagues found that 24 hours after the assigned intervention, participants in the VR group reported sustained improvement in pain severity (1.7 points lower than at baseline) compared with an improvement of just 0.3 points among participants in the control group.

In addition, there was a significant improvement in the VR arm regarding pain bothersomeness (how much the pain bothered them, regardless of pain severity), as well as general distress.

Explaining the rationale behind the study, Groninger noted that while the development of new cancer therapies has grown exponentially over the years, the same can’t be said for pain therapies.

But VR has been shown to be effective in reducing pain in hospitalized patients with heart failure, in those undergoing painful procedures, and a trial of individuals with chronic back pain led to an FDA approval in that setting.

“VR seems to have some promise as a safe, tolerable, feasible, non-drug intervention, and we wanted to explore that in the setting of cancer pain,” Groninger said.

As for the mechanism of action, he explained that the distraction and immersion effect of VR may be impacting the transmission of pain signals. “I think we are in the very early stages of really understanding that,” he said.

One of the challenges, he added, is that studying VR can’t be done with existing technology — such as functional MRI.

Patients in this study had a median age of 59, but ranged from 25 to 86 years. Patients reported high baseline pain burden, with mean scores of 6.6 in the VR group and 6.8 in the control group — scores of 4 or above indicate moderate to severe pain.

Malignant pain was the most commonly reported type of pain in the study participants (75%), while other etiologies included acute nonmalignant pain (21%, this included surgical procedures related to the malignancy), and chronic nonmalignant pain (5%). The vast majority (88%) were on opioid analgesics at the time of study enrollment.

As for how well patients were able to handle the different technologies, 82% of patients in the control group rated the use of the tablet’s two-dimensional guided-imagery experience as easy compared with just 25% of patients in the VR group, and more participants in the VR group rated use of that device as difficult (25% vs 3% for the control group).

“As expected, patients randomized to the handheld tablet arm found it easy to use, and relatively easier to use than VR, which was a novel therapy for almost all of our participants,” Groninger said. “But still, those participants randomized to the VR arm still found it very acceptable, and would use it again.”

In fact, more than 90% of participants in each group said they were willing to use their assigned intervention again. Considering the median age of the study population, this finding is important, Groninger suggested, since it contradicts the stereotypical view that older persons are afraid of new technology.

“I think this is something to continue to explore more,” he said. “Developing non-drug therapies like VR could be particularly important for older populations.”

Going forward, Groninger said he and his colleagues are finishing a pilot study of patients with chronic cancer pain in an outpatient setting, as well as looking at the concept of dosing. He is also involved in trying to develop VR technology geared more to patients, rather than the off-the-shelf VR tools used in studies.

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