Conference PaperPDF Available

The Virtual Meditative Walk: Virtual Reality Therapy for Chronic Pain Management

Authors:

Abstract and Figures

Because the nature of chronic pain is complex, pharmacological analgesics are often not enough to achieve an ideal treatment plan. Virtual Reality (VR) technologies have emerged within medical research in recent years for treating acute pain, and proved to be an effective strategy based on pain distraction. This paper describes a VR system designed for chronic pain patients. The system incorporates biofeedback sensors, an immersive virtual environment, and stereoscopic sound titled the " Virtual Meditative Walk " (VMW). It was designed to enable chronic pain patients to learn Mindfulness-based stress reduction (MBSR), a form of meditation. By providing real-time visual and sonic feedback, VMW enables patients to learn how to manage their pain. A proof-of-concept user study was conducted to investigate the effectiveness of the VR system with chronic pain patients in clinical settings. Results show that the VMW was more effective in reducing perceived pain compared to the non-VR control condition.
Content may be subject to copyright.
The Virtual Meditative Walk: Virtual Reality Therapy
for Chronic Pain Management
Diane Gromala1, Xin Tong1, Amber Choo1, Mehdi Karamnejad1, Chris D. Shaw1
1Simon Fraser University
1250 -13450 102 Avenue
1Surrey, BC V3T 0A3 CANADA
{gromala, tongxint, achoo, mehdi_karamnejad, shaw}@sfu.ca
ABSTRACT
Because the nature of chronic pain is complex,
pharmacological analgesics are often not enough to achieve
an ideal treatment plan. Virtual Reality (VR) technologies
have emerged within medical research in recent years for
treating acute pain, and proved to be an effective strategy
based on pain distraction. This paper describes a VR system
designed for chronic pain patients. The system incorporates
biofeedback sensors, an immersive virtual environment, and
stereoscopic sound titled the “Virtual Meditative Walk”
(VMW). It was designed to enable chronic pain patients to
learn Mindfulness-based stress reduction (MBSR), a form
of meditation. By providing real-time visual and sonic
feedback, VMW enables patients to learn how to manage
their pain. A proof-of-concept user study was conducted to
investigate the effectiveness of the VR system with chronic
pain patients in clinical settings. Results show that the
VMW was more effective in reducing perceived pain
compared to the non-VR control condition.
Author Keywords
Virtual Reality; Chronic Pain; Biofeedback; Mindfulness
Meditation.
INTRODUCTION
An estimated 20% of people in North America [1] and 15-
20% in industrialized nations [2] suffer from chronic pain.
Chronic pain is defined as pain that lasts more than 6
months and persists beyond the healing of its putative
cause. The complexity of this condition involves
neurobiological, psychological and social dimensions, and
as such, no universal treatment exists [3]. Although
pharmacological approaches are the most common
treatment method, they cannot address all aspects of the
condition. Moreover, analgesics such as opioids can have
serious side effects, including dependency and addictive
tendencies [4], and misuse of opioids is a fast-growing
problem among certain patient demographics [5].
One of the standard supplementary or adjuvant approaches
to managing chronic pain is MBSR. The primary goal of
MBSR is to enable patients to reduce stress and improve
their health via improvements in the maintenance of their
psychological states [6]. This is particularly important for
chronic pain patients, as the persistence of pain itself is
stress-inducing. Moreover, because there is currenty no
known cure, and because current treatments present
limitations, many patients are left with a sense of
hopelessness [2].
Hoffman et al. convincingly demonstrated that immersive
Virtual Reality (VR) is an effective way to manage
attention in computer-generated virtual places as a form of
pain distraction [7]. Thus, VR can be used as a powerful
pain control technique and tool for patients to manage and
alleviate their acute or short-term pain [8]. However, it is
not yet known if the analgesic effects of VR persist beyond
the VR sessions. No peer reviewed user studies have yet
been published to investigate whether VR is helpful for
managing chronic pain on a long-term scale.
This paper outlines a novel approach constructed for
managing chronic pain using VR, biofeedback technology
and the MBSR technique. The results of this research
suggest that learning MBSR while immersed in a virtual
environment can lead to further decreases in perceived pain
in contrast to learning MBSR without VR.
RELATED WORK
While treatment of severe chronic pain solely by
pharmacological approaches is limited and problematic [9],
there are alternatives and adjuvant approaches that help
patients manage their long-term pain and reduce its
intensity.
Medical applications of VR have begun to emerge over the
past decade, including rehabilitation, surgical simulators,
and telepresence surgery [10]. In 2003, researchers at the
Georgia Institute of Technology designed an immersive
virtual environment (VE) — the Meditation Chamber — to
train participants to reduce their stress [10]. The researchers
used biofeedback sensors to monitor arousal; this data in
turn affected the visual assets in the VE. Participants were
able to successfully reduce their stress levels while
observing the VE’s continuously changing visual feedback,
and the VE was more effective than biofeedback alone.
Permission to make digital or hard copies of all or part of this work for personal
or classroom use is granted without fee provided that copies are not made o
r
distributed for profit or commercial advantage and that copies bear this notice
and the full citation on the first page. Copyrights for components of this wor
k
owned by others than ACM must be honored. Abstracting with credit is
p
ermitted. To copy otherwise, or republish, to post on servers or to redistribute
to lists, requires prior specific permission and/or a fee. Request permissions
from permissions@acm.org.
CHI 2015, April 18–23, 2015, Seoul, Republic of Korea.
Copyright 2015 © ACM 978-1-4503-3145-6/15/04...$15.00.
http://dx.doi.org/10.1145/2702123.2702344
Making & Sharing Assistive Technologies
CHI 2015, Crossings, Seoul, Korea
521
VR has also proven to be an effective method to reduce
perceived pain during burn wound care [12]. Hoffman et al.
designed a series of distraction-based VR studies in which
patients reported up to 50% reduction in perceived pain.
Although these studies were small, they have been
replicated and extended since 1999. Several other VR
applications not built upon pain distraction were developed
to mitigate pain. Drawing upon the well-known “mirror
therapy” espoused by neuroscientist V.S. Ramachandran,
Murray et al. deployed VR as a solution to treat phantom
limb pain [11]. Although this study was preliminary, the
users reported they felt sensation in their phantom limb and
reported a decrease in phantom pain.
In 2013, Shiri et al. created a VE and biofeedback system to
treat pediatric headaches [12]. They obtained galvanic skin
response (GSR) levels of patients with chronic headaches
over ten sessions, each lasting 30 minutes. The GSR data
was processed and used to affect the VE that the users were
exposed to. The users were instructed to perform relaxation
techniques; as they became more relaxed, the VE showed a
happier picture of them. The researchers reported that
during the intervention, patients with migraines experienced
a significant decrease in headache pain using Visual Analog
Scale [13]. E. Hudlicka also designed and evaluated a
virtual mindfulness coach for patient education and health
behavior training. Results suggested that coach-based
training was more effective compared to self-administered
approaches for mindfulness practices [14].
These works indicate that VR has been effective for treating
acute pain; however, such VEs present limitations for
managing chronic pain. We must consider the inherent
approach in the use of VR for acute pain is based on pain
distraction. It is impossible to distract chronic pain patients
in a VE for significant and frequent periods of time, or
whenever their pain begins to flare. Thus, our research
focuses on utilizing VR as a therapeutic intervention to
teach MBSR, a well-established pain management
technique, which in turn may enable patients to more easily
develop an effective long-term pain management tool.
VIRTUAL MEDITATIVE WALK: USER STUDY DESIGN
AND METHOD
Virtual Meditative Walk
MBSR, a form of mindfulness meditation, is a technique
that takes time and effort to learn. Initially, it requires a
focus on one’s internal states, rather than on the world. The
design of the Virtual Meditative Walk (VMW) provides a
peaceful, non-distracting and safe environment for users to
immerse themselves in as they learn to achieve a stable
meditative practice as they learn to control (or exert agency
over) the physiological aspects that are necessary to achieve
the positive effects of MBSR. The VMW is a VE where
participants immersed in the virtual reality find themselves
“walking” in a beautiful forest composed primarily of a
deciduous forest and undergrowth. The surrounding area is
relatively mountainous, reminiscent of the trails found
along the northwest coast of North America. The camera
slowly moves along a worn dirt pathway, as if the user is
walking. This allows patients to explore the forest without
requiring physical distractions or attention in order to
achieve further passage. (Figure 1.)
The GSR sensors continuously track the patient’s changing
arousal levels, and in turn modify the VMW’s weather. The
light fog in the forest, for example, recedes as a patient’s
GSR levels start to stabilize in favor of a mindful state.
Alternatively, the fog thickens and draws closer when the
patient’s arousal levels increase. This serves as seamless
visual feedback for patients immersed in the VMW. Figure
2 shows how the VE changes according to variabile
changes in the patients’ biofeedback data.
Figure 1. Path design in VMW virtual environment.
Figure 2. As patients approach an inferred meditative
state, the fog begins to dissipate (left to right), and sounds
become more audible and spatial.
Study Intent
This proof-of-concept study was designed to determine if a
Virtual Environment, combined with MBSR training and
biofeedback, helps pain patients better manage their long-
term chronic pain, given the limitations of VR pain
distraction. Will patients fare better using the VMW to
learn MBSR, compared to patients who learn MBSR
without immersive VR? If such a VR intervention is able to
reduce perceived pain levels among chronic pain patients in
a clinical setting, it may be possible that the long-term
benefits for patients learning MBSR to better manage their
long-term persistent pain could be significantly improved.
Our focus groups and participatory design sessions made it
clear that the use of VR itself may impose limitations that
require greater investigation. For example, we found that
some patients cannot sit for more than 20 minutes, that
others cannot tolerate the weight or pressure of a head-
mounted display (HMD) like the Oculus Rift, and that the
planned use of a treadmill was too problematic to use in this
initial stage. And so the study not only served as a proof-of-
concept experiment, but it provided us further insight into
Making & Sharing Assistive Technologies
CHI 2015, Crossings, Seoul, Korea
522
how future studies can be better designed to accommodate
customized patient needs.
Participants & Procedures
Initially, the study included twenty participants. However,
because seven participants refused to fill out the pain
assessment forms, their data was excluded. The participants
who were included comprised thirteen patients from the
Greater Vancouver area, ranging from 35 to 55 years of age
(mean = 49, SD = 8.2); each had a diagnosis of chronic
pain. Six participants (3 male, 3 female) were randomly
assigned to the control group, and the other seven (3 male,
4 female) were assigned to the VR group. The experimenter
introduced each participant to the study, and then attached
the GSR sensors. Participants in the control group were
required to listen to the MBSR training audio track.
Participants in the VR group listened to the same MBSR
training audio track while immersed in the VMW. Firsthand
Technology’s DeepStream VR viewer was used. Patients in
both groups participated in the MBSR training for twelve
minutes.
Figure 3. A participant in the VMW study using the
DeepStream stereoscopic viewer.
Apparatus
The construction of the physical setup for the VMW
required the use of the DeepStream VR viewer, which was
installed in a room in a pain clinic for the study. The
DeepStream is a stereoscopic VR viewer compatible with
PC or Mac computers; it is mounted on a movable arm to
ensure flexibility and to maximize patient comfort. The
DeepStream rests directly in front of the participant’s eyes
and does not grip the head, unlike HMDs such as the
Oculus Rift, which may cause unnecessary discomfort or
pain with this particular participant demographic. The GSR
sensors, which are small clips, were gently put onto two of
the patient’s fingertips; none of the participants reported
discomfort from their use.
Instruments
A simple statistical analysis was conducted before and after
the study session in order to compare perceived reported
pain levels. Study investigators used an 11-point Numerical
Rating Scale (NRS) in which patients self-report their pain
levels between the numerical values 0 and 10; 10 equates to
the worst pain possible and 0 equates to no pain felt. The
NRS instrument was chosen because of its simplicity of
understanding and ease of use, and because the
investigators wanted to avoid distressing the pain patients
with complex and lengthy questionnaires. Prior experience
taught us that these participants, who may already be
feeling some discomfort, end studies prematurely when
confronted with the same lengthy questionnaires that they
are compelled to fill out for most of their clinical visits.
RESULTS AND ANALYSIS
In this study, time and condition were two independent
variables. Time was a within-subjects factor, as every
participant was measured before and after their MBSR
experience. The study used a between-subjects design; a
participant either belonged to the VR group or to the control
group. Therefore, a two-way mixed ANOVA was run to
analyze the collected data. We found a significant main
effect of Time, F(1, 11) = 10.44, p < .01, r = .61. The main
effect of Condition was not significant, F(1, 11) = 1.53, p >
.05, r = .25. This indicated that when the time at which NRS
was measured is ignored, the initial pain level in the VR
group was not significantly different than that in the control
group. There was a significant Time x Condition interaction
(as shown in Figure 4), F(1, 11) = 8.16, p < .05, r = .54,
indicating that the changes in the pain level in the VR group
were significantly different compared to the change in the
control group. Specifically, there was a significant drop in
NRS ratings in the VR group, t(6) = 2.86, p < .05, r = .57,
but a very weak drop in the control group, t(5) = 1.24, p >
.05, r = .26. These findings indicate that the VMW (VR
paired with biofeedback for MBSR training) was
significantly more effective than MBSR alone at reducing
reported pain levels among participants. LS Means test
results are shown in Figure 4.
Figure 4. VR and Control Groups NRS Rating LS mean
value before and after experiment
DISCUSSION
It is promising to examine the pain reduction reported by
participants in the VMW study, as the impact the VR had
on chronic pain patients occurred after such a short amount
of time. Compared to the control group, the VR group
experienced a reduction of pain, on average, equalling 2.6
on the NRS scale. One must also consider that the patients
themselves were only immersed in the VR for twelve
minutes, which is a short amount of time for an MBSR
session. Future studies with longer immersion times and a
focus on how long the analgesic effect may linger after the
meditative session is the natural next step in continuing this
line of inquiry. The introduction of more detailed reporting
methods of perceived pain, such as the use of the McGill
Making & Sharing Assistive Technologies
CHI 2015, Crossings, Seoul, Korea
523
Pain Questionnaire, could also yield new insights into the
details surrounding perceived reported pain after the VR
intervention. This will require greater effort put towards the
understanding of pain patient experience within the context
of the clinic to ensure their comfort and stamina are not
negatively impacted.
Although the single trial outlined does not speak to the
effectiveness of potential long-term capabilities for VR
chronic pain management, the VMW enables chronic pain
patients to consider that their pain experiences could be
further managed through MBSR practiced over the long-
term. By multiple training sessions and regularized practice,
patients can learn to more easily situate the psychophysical
mediation of their internal experiences into everyday life.
The pain reduction reported by the NRS data is an early
step in proving that VR and biofeedback systems may be an
effective first step in promoting this behavioural change.
The VMW was designed using a cross-platform game
engine that enables researchers or patients to run the VMW
on a wide variety of devices, including handheld phones
and tablets. These could enable patients to enhance their
MBSR skills in a more easily accessible manner outside of
clinical settings. This would also allow researchers and
health practitioners to extend the use of VR technology
from research and clinical settings to patient homes. To
achieve this goal, a key approach would be to migrate the
current VE to devices patients already own. Smaller,
portable stereoscopic viewers could also be used with
mobile devices such as Google Cardboard or the FOV2GO,
both of which are low-budget stereoscopic viewing devices;
this approach is currently being investigated by the study
investigators for future work.
CONCLUSION
In this paper, we discussed how a VR intervention, in
conjunction with MBSR and biofeedback, was better able
to invoke positive results in chronic pain patients, compared
to MBSR alone. This approach could be an effective non-
pharmacological alternative or supplementary method to
existing pain management strategies. By teaching
mindfulness meditation to patients in this context, we
believe that pain patient health may be improved over time.
REFERENCES
1. Macfarlane G. J., McBeth J., and Silman A. J.,
Widespread body pain and mortality: prospective
population based study. BMJ, 323 (2001), 662–665.
2. Gatchel R. J., Peng Y. B., Peters M. L., Fuchs P. N.,
and Turk D. C., The biopsychosocial approach to
chronic pain: scientific advances and future directions.
Psychol. Bull., 133 (2007), 581–624.
3. Fishbain D. A., Cole B., Lewis J., Rosomoff H. L., and
Rosomoff R. S., What percentage of chronic
nonmalignant pain patients exposed to chronic opioid
analgesic therapy develop abuse/addiction and/or
aberrant drug-related behaviors? A structured
evidence-based review. Pain Med. Malden Mass, 9
(2008), 444–459.
4. Jamison R. N., Ross E. L., Michna E., Chen L. Q.,
Holcomb C., and Wasan A. D., Substance misuse
treatment for high-risk chronic pain patients on opioid
therapy: a randomized trial. Pain, 150 (2010), 390–
400.
5. Reibel D. K., Greeson J. M., Brainard G. C., and
Rosenzweig S., Mindfulness-based stress reduction
and health-related quality of life in a heterogeneous
patient population. Gen. Hosp. Psychiatry, 23 (2001),
183–192.
6. Hoffman H. G., Chambers G. T., Meyer W. J.,
Arceneaux L. L., Russell W. J., Seibel E. J., Richards
T. L., Sharar S. R., and Patterson D. R., Virtual reality
as an adjunctive non-pharmacologic analgesic for
acute burn pain during medical procedures. Ann.
Behav. Med. Publ. Soc. Behav. Med., 41 (2011), 183–
191.
7. Hoffman H. G., Patterson D. R., Carrougher G. J., and
Sharar S. R., Effectiveness of virtual reality-based pain
control with multiple treatments. Clin. J. Pain, 17
(2001), 229–235.
8. Baer R. A., Mindfulness Training as a Clinical
Intervention: A Conceptual and Empirical Review.
Clin. Psychol. Sci. Pract., 10 (2003), 125–143.
9. Satava R. M., Surgical robotics: the early chronicles: a
personal historical perspective. Surg. Laparosc.
Endosc. Percutan. Tech., 12 (2002), 6–16, Feb.2002.
10. Shaw C., Gromala D., and Song M., The Meditation
Chamber: Towards Self-Modulation. Proc. ENACTIVE
(2007), 121–133.
11. Murray C. D., Pettifer S., Howard T., Patchick E. L.,
Caillette F., Kulkarni J., and Bamford C., The
treatment of phantom limb pain using immersive
virtual reality: three case studies. Disabil. Rehabil., 29
(2007), 1465–1469.
12. Shiri S., Feintuch U., Weiss N., Pustilnik A., Geffen
T., Kay B., Meiner Z., and Berger I., A virtual reality
system combined with biofeedback for treating
pediatric chronic headache--a pilot study. Pain Med.
Malden Mass, 14 (2013), 621–627.
13. Varni J. W., Seid M., and Rode C. A., The PedsQL:
measurement model for the pediatric quality of life
inventory. Med. Care, 37 (1999), 126–139.
14. Hudlicka E., Virtual training and coaching of health
behavior: example from mindfulness meditation
training. Patient Education and Counseling, 92 (2013),
160-166.
Making & Sharing Assistive Technologies
CHI 2015, Crossings, Seoul, Korea
524
... The included studies were mostly conducted in United States of America (USA) (15/32) and as pilot or feasibility studies (15/32) ( Table 1). There were 19 controlled study design of which were randomised control trials (RCTs) [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] with two controlled trials 52,53 and one RCT of cross over design. 54 In the controlled trials, the IVR in the intervention was compared to either standard rehabilitation, [36][37][38][39]46,48,49,51,52,54,55 sham VR (HMD with two dimensional video), 41-45 audio intervention 50,51 or had control groups with no intervention. ...
... There were 19 controlled study design of which were randomised control trials (RCTs) [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] with two controlled trials 52,53 and one RCT of cross over design. 54 In the controlled trials, the IVR in the intervention was compared to either standard rehabilitation, [36][37][38][39]46,48,49,51,52,54,55 sham VR (HMD with two dimensional video), 41-45 audio intervention 50,51 or had control groups with no intervention. 40,45,47,48 Study designs also include seven pre-post trials, [55][56][57][58][59][60][61] five case studies 62-66 and one randomised cross over. ...
... 65 The remaining nine studies were conducted on conditions identified as having non-specific CP (Table 1). [50][51][52][53][54]60,61,66,67 There were common exclusion criteria of CPP conditions noted across studies including susceptibility to motion sickness (11/32), 41 [40][41][42][43][44]46,47,49,56,58,60,64 Also, other studies excluded patients who reported to have psychiatric disorder or severe symptoms of depression (10/ 27) [41][42][43][44][45]48,56,57,61,64 as well as those with medical condition or severe disability that interfered with movement and /or balance in CNP, CLBP and fibromyalgia (7/27) ( Table 1). [36][37][38]45,46,49,59 Mechanisms of action and associated effect on the intended outcomes Six distinct mechanisms of action (see details Appendix 2) were employed in the identified studies including distraction (5/32), 52 65 as well as multi-mechanisms (2/27). ...
Article
Full-text available
Background The use of immersive virtual reality, wearing head mounted display, has recently increased for people with chronic pain, with no definitive conclusion of its efficacy on pain-related outcomes. Objective To map the available evidence on the use of immersive virtual reality as intervention for adults with chronic primary pain, illustrating gap in knowledge and direct future research. Methods The search was performed with a range of study designs, but only those written in English language. A search was created in CINAHL Plus, Medline, AMED, Embase, PsycINFO, ASSIA, Scopus, TripPro, CENTRAL and EmCare. Results Thirty-two studies were included. Several chronic conditions were identified including chronic musculoskeletal pain and fibromyalgia. The immersive virtual reality mechanisms included distraction, physical exercises, mindfulness/biofeedback, graded exposure, hypnosis, neuromodulation, and multi-mechanisms, and all these mechanisms were associated with varied dose. The use of customised software, with wide range of head mounted displays were common in clinical setting with some degree of supervision. Motion sickness, head mounted display discomfort and technical issues affect the usability of immersive virtual reality leading to poor engagement and dropouts. Conclusions The use of immersive virtual reality for chronic primary pain is in early stages with lack of consensus regarding the mechanisms and associated dose. Future research needs to address the need of customisation, clinical usability of head mounted display as well as safety strategies to enhance the uptake of immersive virtual reality technology in healthcare practice.
... The results of this study represent a significant step in understanding the effectiveness of VR-assisted therapy in treating SIS (Gromala et al., 2015;Chang, 2004). By analysing the progress of the patients during the treatment sessions, it was observed that VR therapy had a positive impact on the functionality of the shoulder, as assessed by the Constant-Murley Score (CMS). ...
Article
Full-text available
p dir="ltr"> Subacromial impingement syndrome (SIS) is a common problem in clinical practice that affects the functionality of the shoulder. This study investigates the effectiveness of virtual reality (VR) assisted therapy in treating this syndrome, focusing on assessment using the Constant-Murley shoulder score. Materials and Methods: A group of 288 participants was randomly divided into two categories: an experimental group that received VR therapy and a control group that underwent conventional therapy. The Constant-Murley shoulder score assessed patients' progress, measuring shoulder function, joint mobility, and associated pain. Results: The participants underwent therapeutic interventions for 50 weeks, and the results were compared between the two groups. The experimental group that benefited from VR therapy showed significant improvements in Constant-Murley scores, indicating an increase in shoulder functionality, joint mobility, and pain reduction compared to the control group. Conclusion: VR therapy has proven effective in improving shoulder functionality in patients with SIS according to the Constant-Murley score. These results support the use of VR as an innovative and promising therapeutic option in treating this musculoskeletal condition. </div
... With the development of immersive technologies, including VR, studies on metaverse application are underway to present an expanded virtual environment in which reality and unreality are socially connected, including the economy, society, and culture. In this regard, innovative content is being developed in areas such as schools by improving learning experiences through virtual classrooms and simulations [21], the medical field by supporting patient diagnosis and treatment [22], and even the entertainment industry, such as by virtual concerts and events [23]. Social goods were examined using a university campus prototype [24]. ...
Article
Full-text available
This study proposes an improved object arrangement and a layout design including movement path and location recommendation algorithm that considers the systematic interaction of virtual reality (VR) users participating in the created virtual scene for efficient and realistic indoor scene synthesis in immersive VR. First, we propose a new object labeling technique as an improved arrangement method based on existing object arrangement optimization. It has a top-down structure wherein commonalities between objects, reset of pairwise relationship objects, and cost calculation process for each object in objects movement are grouped for arrangement. Next, we design a layout that considers VR user participation as a way to apply the created virtual scene to immersive VR. This diversifies the object arrangement pattern by considering not only the rectangular wall layout but also the concave structure layout. In addition, we propose a method to recommend the location of VR users according to the interaction host such that VR users can interact effectively and organically within the defined layout. Consequently, through comparative analysis with existing approaches, the performance of the proposed method was verified and improved results were confirmed. The process of generating natural indoor scene synthesis results was confirmed through step-by-step application of the labeling method.
... [25] and [16] propose a 15-minute guided mindfulness practice in VR composed of 360-degree video footage of a forest, ambient sounds originating from the forest, and voice guidance. On a similar note, the Virtual Meditative Walk [14] is a VR-based environment that allows the user to be immersed in a virtual forest, with the camera "slowly moving along a worn dirt pathway". These applications reduce interaction to navigation within the environment (e.g., visual exploration by moving ahead). ...
Article
Background Fibromyalgia Syndrome (FMS) is highly prevalent with a significant associated morbidity and socioeconomic burden. Effective treatments for FMS remain elusive with pharmacological management (including use of opioids) often proving ineffective. There is a need to develop accessible, innovative management approaches to improve patient care. Virtual reality (VR) interventions have shown evidence of efficacy in the management of acute pain and chronic low back pain, but their feasibility in FMS has not hitherto been explored. Methods This feasibility study investigates the use of four different VR systems, four interactive VR activities and two virtual environments in patients with FMS. Acceptability (including adverse effects) and study engagement were the main outcomes investigated. Clinical outcome data on pain and mood were also collected to gather preliminary information for future studies. Results The results demonstrated good feasibility across VR systems, activities and virtual environments with high levels of acceptability, low frequency of adverse effects, and positive perceptions of VR in patients with FMS. Reporting of adverse effects (including fatigue) varied across different VR components, with system comfort and virtual environmental design being particularly important. Conclusions The findings increase our confidence with respect to the feasibility of using VR in people with FMS, help to inform future randomised controlled trials and emphasise the importance of tailored interventional design for future VR therapeutics.
Chapter
Strong evidence supports several psychotherapies to treat posttraumatic stress disorder (PTSD). First-line cognitive behavioral therapies (CBTs) include cognitive processing therapy (CPT), cognitive therapy for PTSD, and exposure-based approaches such as prolonged exposure (PE) (International Society for Traumatic Stress Studies [ISTSS], 2018). In ISTSS’ most recent practice guidelines, virtual reality exposure therapy (VRET) for PTSD is noted to have emerging evidence of efficacy (ISTSS, 2018). Although VRET shares many of the foundational principles of PE, it is a distinct treatment that was developed independently. Early studies using VR technology for exposure to treat PTSD (e.g., Rothbaum et al., 2001; Difede & Hoffman, 2002) occurred before there was a standard of care for PTSD and before the PE manual was published (Foa et al., 2007), and thus do not follow the exact same protocol. Although it is possible to utilize the standard PE protocol within VR, the term “VRET” that is used throughout this chapter encapsulates a range of exposure-based PTSD treatments, some of which are closer to the standard PE protocol than others. VRET has garnered a strong empirical base spanning nearly three decades and is a promising therapy for PTSD. VRET is an important method for delivering exposure-based PTSD treatments that may be particularly useful for those unable or unwilling to effectively engage in alternate forms of delivery, such as standard PE.
Conference Paper
Full-text available
Sanal gerçeklik teknolojisi, katılımcıların sanal ortamda olduğu yanılsamasını hissetmesi, orada olma hissini yaşamasıdır. Sanal gerçeklik teknolojisi sağlık alanında çeşitli amaçlarla kullanılmaktadır. Çocuk sağlığı da bu alanlardan biri olabilir. Bu çalışmada sanal gerçeklik teknolojisinin kullanım alanları ve belirlenen faydaları ele alınmış, çocuklarda sanal gerçeklik uygulamaları kullanımı üzerinde durulmuştur. Sanal gerçeklik uygulama örneklerine yer verilerek çocuklara yönelik sanal gerçeklik uygulamalarının çocuk sağlığı ve gelişimine katkılarının neler olabileceği ortaya konmuştur. Sanal gerçeklik teknolojisinin kullanım alanlarının çeşitlendirilebilmesi, geleneksel yöntemlerle elde edilmesi güç olan ilerlemelerin bu yolla sağlanması için yapılan çalışmaların bilinmesine ihtiyaç olduğu düşünülmektedir. Bu bağlamda çocuk sağlığı ve gelişiminde sanal gerçeklik uygulama alanlarına yönelik öneriler geliştirilmiştir.
Article
Full-text available
Introduction Caregivers of patients with end-stage kidney disease (ESKD) face significant challenges that contribute to caregiver burden, negatively impacting their psychosocial well-being. Virtual-reality (VR)-guided mindfulness interventions have shown promise in reducing stress, anxiety and depression in various populations. Methods and analysis This pilot study aims to evaluate the efficacy and feasibility of a VR-guided mindfulness intervention for ESKD caregivers. A single-centre, single-blind, parallel-group pilot randomised controlled trial will be conducted. Thirty ESKD caregivers will be randomly allocated to either the VR-guided mindfulness intervention group or the sham VR control group. The intervention group will receive a 6 week home-based VR-guided mindfulness programme, while the control group will view relaxing nature videos without mindfulness content. Participants will be assessed at baseline, post-intervention (6 weeks) and follow-up (12 weeks) using validated questionnaires for caregiver burden (Zarit Burden Interview (ZBI)), stress, anxiety, depression (Depression Anxiety Stress Scale-21 (DASS-21)), quality of life (36-Item Short Form Health Survey (SF-36)) and mindfulness (Five Facet Mindfulness Questionnaire (FFMQ)). Feasibility outcomes include accrual rates, retention, adherence, questionnaire completion and side effect rates. Semi-structured interviews will explore participants’ experiences with the intervention. Ethics and dissemination The study has been approved by the NHG Domain Specific Review Board (Reference: 2024–3940-APP1). The results of this pilot study will be reported in peer-reviewed open-access journals and shared with participants and stakeholders. Trial registration NCT06479200 .
Chapter
The chapter explores the transformative impact of three technologies in healthcare: the metaverse, explainable AI (XAI), and wearable devices. The metaverse enables virtual consultations and training, XAI improves AI model transparency and trust, and wearables provide real-time health monitoring. These technologies together create a patient-centered ecosystem, enhancing diagnostic accuracy and personalized care. The chapter also addresses challenges like medical data security and regulatory needs, presenting a balanced view of the future of healthcare.
Article
Full-text available
The Meditation Chamber is an immersive virtual environment (VE), initially created to enhance and augment the existing methods of training users how to meditate, and by extension, to realize the benefits from meditation practice, including the reduction of stress, anxiety and pain. Its innovative combination of immersive virtual reality (VR) and biofeedback technologies added interoceptive or dimensions of inner senses to the already sensorially rich affordances of VR. Because the Meditation Chamber enabled users to become aware of autonomic senses that they are not normally conscious of, and to manipulate them in real-time, we found that it did enhance users' abilities to learn how to meditate, particularly those who had never meditated. We describe the Meditation Chamber, scientific methods of evaluation and findings, and discuss first-person phenomenological aspects, its long-term applicability for users who have chronic pain, and future directions.
Article
Full-text available
Interventions based on training in mindfulness skills are becoming increasingly popular. Mindfulness involves intentionally bringing one's attention to the internal and external experiences occurring in the present moment, and is often taught through a variety of meditation exercises. This review summarizes conceptual approaches to mind-fulness and empirical research on the utility of mindfulness-based interventions. Meta-analytic techniques were incorporated to facilitate quantification of findings and comparison across studies. Although the current empirical literature includes many methodological flaws, findings suggest that mindfulness-based interventions may be helpful in the treatment of several disorders. Methodologically sound investigations are recommended in order to clarify the utility of these interventions.
Article
Full-text available
Design: This is a structured evidence-based review of all available studies on the development of abuse/addiction and aberrant drug-related behaviors (ADRBs) in chronic pain patients (CPPs) with nonmalignant pain on exposure to chronic opioid analgesic therapy (COAT). Objectives: To determine what percentage of CPPs develop abuse/addiction and/or ADRBs on COAT exposure. Method: Computer and manual literature searches yielded 79 references that addressed this area of study. Twelve of the studies were excluded from detailed review based on exclusion criteria important to this area. Sixty-seven studies were reviewed in detail and sorted according to whether they reported percentages of CPPs developing abuse/addiction or developing ADRBs, or percentages diagnosed with alcohol/illicit drug use as determined by urine toxicology. Study characteristics were abstracted into tabular form, and each report was characterized according to the type of study it represented based on the Agency for Health Care Policy and Research Guidelines. Each study was independently evaluated by two raters according to 12 quality criteria and a quality score calculated. Studies were not utilized in the calculations unless their quality score (utilizing both raters) was greater than 65%. Within each of the above study groupings, the total number of CPPs exposed to opioids on COAT treatment was calculated. Similarly, the total number of CPPs in each grouping demonstrating abuse/addiction, ADRBs, or alcohol/illicit drug use was also calculated. Finally, a percentage for each of these behaviors was calculated in each grouping, utilizing the total number of CPPs exposed to opioids in each grouping. Results: All 67 reports had quality scores greater than 65%. For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%. For the ADRB grouping, there were 17 studies with 2,466 CPPs exposed and a calculated ADRB rate of 11.5%. Within this grouping for preselected CPPs (as above), the percentage of ADRBs was calculated at 0.59%. In the urine toxicology grouping, there were five studies (15,442 CPPs exposed). Here, 20.4% of the CPPs had no prescribed opioid in urine and/or a nonprescribed opioid in urine. For five studies (1,965 CPPs exposed), illicit drugs were found in 14.5%. Conclusion: The results of this evidence-based structured review indicate that COAT exposure will lead to abuse/addiction in a small percentage of CPPs, but a larger percentage will demonstrate ADRBs and illicit drug use. These percentages appear to be much less if CPPs are preselected for the absence of a current or past history of alcohol/illicit drug use or abuse/addiction.
Article
Full-text available
Excessive pain during medical procedures is a widespread problem but is especially problematic during daily wound care of patients with severe burn injuries. Burn patients report 35-50% reductions in procedural pain while in a distracting immersive virtual reality, and fMRI brain scans show associated reductions in pain-related brain activity during VR. VR distraction appears to be most effective for patients with the highest pain intensity levels. VR is thought to reduce pain by directing patients' attention into the virtual world, leaving less attention available to process incoming neural signals from pain receptors. We review evidence from clinical and laboratory research studies exploring Virtual Reality analgesia, concentrating primarily on the work ongoing within our group. We briefly describe how VR pain distraction systems have been tailored to the unique needs of burn patients to date, and speculate about how VR systems could be tailored to the needs of other patient populations in the future.
Article
The use of robotics has been emerging for approximately 75 years, but only during the past 5 years has the potential of robotics been recognized by the surgical community as a whole. This personal perspective chronicles the development of robotics for the general surgical community, the role of the military medical research effort, and many of the major programs that contributed to the current success of robotics.
Article
Pediatric headache is highly widespread and is associated with distress and reduced quality of life. Pharmacological treatment of chronic headache in children has been only partially effective and, as in medication-overuse headache, can sometimes be counterproductive. Therefore, there is a substantial need to develop other effective methods of treatment. Here we present the rationale, feasibility, and preliminary results of a pilot study applying a novel system, combining virtual reality and biofeedback, aimed as an abortive treatment of pediatric chronic headache. A prospective single-arm open-label, pilot study. Ten children attending an outpatient pediatric neurology clinic were treated by the proposed system. Participants practiced relaxation with biofeedback and learned to associate successful relaxation with positive pain-free virtual images of themselves. Nine patients completed the 10-session intervention. Ratings of pain, daily functioning, and quality of life improved significantly at 1 and at 3 months posttreatment. Most patients reported applying their newly acquired relaxation and imagery skills to relieve headache outside the lab. This novel system, combining biofeedback and virtual reality, is feasible for pediatric use. Randomized controlled studies in larger populations are needed in order to determine the utility of the system in reducing headache, improving daily functioning, and elevating quality of life.
Article
Objective: To determine whether there is excess mortality in groups of people who report widespread body pain, and if so to establish the nature and extent of any excess.Design: Prospective follow up study over eight years. Mortality rate ratios were adjusted for age group, sex, and study location.Setting: North west England.Participants: 6569 people who took part in two pain surveys during 1991-2.Main outcome measures: Pain status at baseline and subsequent mortality.Results: 1005 (15%) participants had widespread pain, 3176 (48%) had regional pain, and 2388 (36%) had no pain. During follow up mortality was higher in people with regional pain (mortality rate ratio 1.21, 95% confidence interval 1.01 to 1.44) and widespread pain (1.31, 1.05 to 1.65) than in those who reported no pain. The excess mortality among people with regional and widespread pain was almost entirely related to deaths from cancer (1.55 (1.09 to 2.19) for regional pain and 2.07 (1.37 to 3.13) for widespread pain). The excess cancer mortality remained after exclusion of people in whom cancer had been diagnosed before the original survey and after adjustment for potential confounding factors. There were also more deaths from causes other than disease (for example, accidents, suicide, violence) among people with widespread pain (5.21, 0.94 to 28.78).Conclusion: There is an intriguing association between the report of widespread pain and subsequent death from cancer in the medium and long term. This may have implications for the long term follow up of patients with “unexplained” widespread pain symptoms, such as those with fibromyalgia.What is already known on this topicWhat is already known on this topic Widespread body pain, the cardinal symptom of fibromyalgia, is commonAn organic basis for symptoms is found in only a small proportion of people Treatment is difficult, and studies with short term follow up have shown that symptoms commonly persist
Article
Chronic pain patients who show aberrant drug-related behavior often are discontinued from treatment when they are noncompliant with their use of opioids for pain. The purpose of this study was to conduct a randomized trial in patients who were prescribed opioids for noncancer back pain and who showed risk potential for or demonstration of opioid misuse to see if close monitoring and cognitive behavioral substance misuse counseling could increase overall compliance with opioids. Forty-two patients meeting criteria for high-risk for opioid misuse were randomized to either standard control (High-Risk Control; N=21) or experimental compliance treatment consisting of monthly urine screens, compliance checklists, and individual and group motivational counseling (High-Risk Experimental; N=21). Twenty patients who met criteria indicating low potential for misuse were recruited to a low-risk control group (Low-Risk Control). Patients were followed for 6 months and completed pre- and post-study questionnaires and monthly electronic diaries. Outcomes consisted of the percent with a positive Drug Misuse Index (DMI), which was a composite score of self-reported drug misuse (Prescription Drug Use Questionnaire), physician-reported abuse behavior (Addiction Behavior Checklist), and abnormal urine toxicology results. Significant differences were found between groups with 73.7% of the High-Risk Control patients demonstrating positive scores on the DMI compared with 26.3% from the High-Risk Experimental group and 25.0% from the Low-Risk Controls (p<0.05). The results of this study demonstrate support for the benefits of a brief behavioral intervention in the management of opioid compliance among chronic back pain patient at high-risk for prescription opioid misuse.