Virtual reality therapy offers ‘sustained improvement’ in cancer-related pain
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Key takeaways:
- Individuals with cancer had significant drops in self-reported pain scores following a 10-minute virtual-reality session.
- Pain reduction persisted for 24 hours after the intervention.
Individuals with cancer reported significantly reduced pain immediately following a 10-minute virtual reality (VR) session, study results published in Cancer showed.
The findings from the randomized trial suggest that pain reductions associated with VR use are sustainable for up to 24 hours and produced a reduction in pain bothersomeness and destress, according to researchers.
“VR has promise to improve cancer-related pain, perhaps more than other readily available distraction therapies,” Hunter Groninger, MD, director of palliative care at MedStar Washington Hospital Center, told Healio. “It is safe, easy to use and enjoyable, even for patients who have never tried this technology before.”
Background and methodology
Pain is common among patients with cancer, with more than 50% reporting it at early stages of the disease, and 75% or greater among those with progressive and advanced cancers, according to background information provided by researchers.
“Despite such high prevalence, successful, consistent pain management among cancer survivors remains elusive, largely because of provider discomfort managing opioids, poor implementation of pain management guidelines, and lack of novel analgesic drug development,” Groninger and colleagues wrote.
VR, which can immerse individuals in calm settings, has produced results in reducing pain for hospitalized patients, those undergoing painful procedures and those with lower back pain.
It has also been investigated for reducing anxiety, depression, fatigue and procedure-related pain in individuals with cancer, specifically among pediatric patients and those with breast cancer.
“But there had been few developments in the space of cancer-related pain,” Groninger said.
Groninger and colleagues tested VR vs. two-dimensional (2D) guided imagery distraction therapy for their study.
The trial included adults aged at least 18 years who had an active cancer diagnosis and hospitalized at MedStar experiencing pain severity of at least 4 on the Likert scale within 24 hours of the intervention.
The data analysis included 127 participants (mean age, 59.4 years; 61% women; 72% Black; 71% with metastatic disease). The 64 patients in the VR group had a mean baseline pain score of 6.6 compared with 6.8 among the 63 individuals in the 2D cohort.
Study participants in the VR group experienced a natural environment with birds, trees and ocean waves for 10 minutes. Those in the 2D cohort saw landscapes with mediational background music.
Self-reported pain scores before and after therapy served as the study’s primary endpoint. Secondary outcomes included average pain, pain bothersomeness and satisfaction with pain management over the previous 24 hours, and self-reported distress in the past week.
Results and next steps
Both cohorts experienced statistically significant reductions in pain pain after treatment. Nevertheless, VR participants had a larger reported drop (1.4 vs. 0.7; P = .03).
The VR cohort also experienced significant improvement in self-reported pain scores after 24 hours (4.9 vs. 6.5; P = .004).
“We did not expect this sustained improvement,” Groninger said. “This is something we are excited to study in greater depth in future trials.”
VR also lowered distress (P = .03) and pain bothersomeness (P = .05), but did not produce meaningful differences for average pain, self-reported distress and satisfaction with pain management.
VR participants had more difficultly using their technology than the 2D group, but results suggest both cohorts would use them again.
“We need to consider this a first step to understand how VR therapies may help pain management in different clinical settings and different patient populations,” Groninger said. “But I would feel comfortable saying that, even today, if a patient wants to try an immersive VR experience to improve their pain, it is safe to try and may in fact be helpful.”
Groninger mentioned many questions that must be answered for VR to be more integrated into oncology practices.
The list includes determining which patients derive the most benefit from VR interventions, whether some VR experiences are more effective, and investigating the “neural mechanism” that allows immersive VR to improve acute vs. chronic pain, he said.
“Most of all, what do our patients want from VR and how we can support them?” Groninger said. “As we answer these questions, we can learn how best and most equitably to implement VR as a therapeutic option for patients in and out of the hospital.”
Groninger added that there could come a day when clinicians might prescribe VR therapies, or they will be used before medication starts working, or the FDA will approve them.
“Patients with cancer pain are really looking for new nondrug strategies to improve pain control,” he said. “Some of the most enthusiastic participants have been those who rarely use any technology, not to mention VR itself. For providers, I would say to avoid approaching VR clinical applications with biases about which patients want them. They all are interested. We must engage our patients in this work now. VR therapies are developing rapidly as the technology evolves quickly. We will only be successful if our patients become our partners on this pathway.”
For more information:
Hunter Groninger, MD, can be reached at hunter.groninger@medstar.net.
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